European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients.
OBJECTIVE
This report summarizes the 5-year clinical and haemodynamic data from three prospective, European multicentre trials with the Perceval sutureless aortic valve.


METHODS
From April 2007 to August 2012, 731 consecutive patients (mean age: 78.5 years; 68.1% females; mean logistic EuroSCORE 10.9%) underwent AVR with the Perceval valve in 25 European centres. Isolated AVR was performed in 498 (68.1%) patients. A minimally invasive approach was performed in 189 (25.9%) cases. The cumulative follow-up was 729 patients-years.


RESULTS
In isolated AVR, mean cross-clamp and cardiopulmonary bypass times were 30.8 and 50.8 min in full sternotomy, and 37.6 and 64.4 min in the minimally invasive approach, respectively. Early cardiac-related deaths occurred in 1.9%. Overall survival rates at 1 and 5 years were 92.1 and 74.7%, respectively. Major paravalvular leak occurred in 1.4% and 1% at early and late follow-up, respectively. Significant improvement in clinical status was observed postoperatively in the majority of patients. Mean and peak gradients decreased from 42.9 and 74.0 mmHg preoperatively, to 7.8 and 16 mmHg at the 3-year follow-up. LV mass decreased from 254.5 to 177.4 g at 3 years.


CONCLUSIONS
This European multicentre experience, with the largest cohort of patients with sutureless valves to date, shows excellent clinical and haemodynamic results that remain stable even up to the 5-year follow-up. Even in this elderly patient cohort with 40% octogenarians, both early and late mortality rates were very low. There were no valve migrations, structural valve degeneration or valve thrombosis in the follow-up. The sutureless technique is a promising alternative to biological aortic valve replacement.
Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany shrestha.malakh.lal@mh-hannover.de.
Malakh
M
Shrestha
Klinikum Nuernberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Theodore
T
Fischlein
Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
Bart
B
Meuris
Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
Willem
W
Flameng
Inselspital, Bern, Switzerland.
Thierry
T
Carrel
Hospital Cardiologique Du Haut-Leveque, Pessac, France.
Francesco
F
Madonna
Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie, Leipzig, Germany.
Martin
M
Misfeld
Cardiac Medico-Surgical Department, Institute Mutualiste Montsouris, Paris, France.
Thierry
T
Folliguet
Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Axel
A
Haverich
Cardiac Medico-Surgical Department, Institute Mutualiste Montsouris, Paris, France.
Francois
F
Laborde
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000502:physiology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
Aortic valve replacement; Prospective study; Sutureless heart valve prosthesis