Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†.
OBJECTIVE
The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching.


METHODS
Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%).


RESULTS
After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P  < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n  = 62). In the sutured group ( n  = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n  = 26) and severe in 19.4% ( n  = 12) ( P  < 0.001).


CONCLUSIONS
The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Igor
I
Belluschi
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Stefano
S
Moriggia
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Andrea
A
Giacomini
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Benedetto
B
Del Forno
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Stefania
S
Di Sanzo
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Andrea
A
Blasio
Department of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy.
Antonio
A
Scafuri
Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
Ottavio
O
Alfieri
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013537:Sutures / Q000009:adverse effects / Q000706:statistics & numerical data
Aortic; Effective orifice area; Patient prosthesis mismatch.; Sutureless; Valve