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Background <p>The Perceval Sutureless prosthesis can increase the effective orifice area (EOA) and reduce the chance of prosthesis–patient mismatch (PPM). This report presents three patients with challenging degenerated bioprosthetic valves undergoing redo aortic valve replacement (rAVR) using the Perceval (LivaNova, London, UK) prosthesis from a cohort of more than 300 performed cases and a review of the literature on the management of challenging degenerated valves.</p> Methods <p>Case 1: Degenerated 23&#xa0;mm Trifecta with the valve cage densely adherent to the annulus. Cage with sewing ring were excised and annulus sized to a large Perceval valve. Case 2: Degenerated 29&#xa0;mm Epic from a Bentall’s procedure. Calcified and rigid prosthetic leaflets as well as stent posts were excised and XL Perceval implanted. Case 3: Degenerated 27&#xa0;mm Epic with signs of endocarditis from a history of Bentall’s procedure. Three calcified leaflets of the Epic valve were completely excised. The orifice accepted a medium Perceval.</p> Results <p>The total Cardiopulmonary Bypass (CPB) and aortic cross clamp (ACC) times (in minutes) were 99.76, 117.68 and 143.99 in Cases 1, 2 and 3, respectively. Moreover, post-implantation transesophageal echocardiogram (TOE) demonstrated a well-seated valve, no paravalvular leak in all cases and a peak gradient of 12.7 mmHg, 14.8 mmHg and 17.7 mmHg in Cases 1, 2 and 3, respectively.</p> Conclusion <p>The Perceval prosthesis is an excellent choice for rAVR, as it can safely simplify challenging cases at risk of PPM and is an excellent valve-in-valve alternative to degenerated or infected Bentall valves with patent graft. The Perceval prosthesis can be well seated on the different structures of a degenerated bioprosthetic valve.</p>

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Perceval prosthesis implantation into challenging degenerated aortic valves: a literature review and case series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月9日

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  • Pouya Nezafati,
  • Chimezi Uchime,
  • Sumit Yadav

摘要

Background

The Perceval Sutureless prosthesis can increase the effective orifice area (EOA) and reduce the chance of prosthesis–patient mismatch (PPM). This report presents three patients with challenging degenerated bioprosthetic valves undergoing redo aortic valve replacement (rAVR) using the Perceval (LivaNova, London, UK) prosthesis from a cohort of more than 300 performed cases and a review of the literature on the management of challenging degenerated valves.

Methods

Case 1: Degenerated 23 mm Trifecta with the valve cage densely adherent to the annulus. Cage with sewing ring were excised and annulus sized to a large Perceval valve. Case 2: Degenerated 29 mm Epic from a Bentall’s procedure. Calcified and rigid prosthetic leaflets as well as stent posts were excised and XL Perceval implanted. Case 3: Degenerated 27 mm Epic with signs of endocarditis from a history of Bentall’s procedure. Three calcified leaflets of the Epic valve were completely excised. The orifice accepted a medium Perceval.

Results

The total Cardiopulmonary Bypass (CPB) and aortic cross clamp (ACC) times (in minutes) were 99.76, 117.68 and 143.99 in Cases 1, 2 and 3, respectively. Moreover, post-implantation transesophageal echocardiogram (TOE) demonstrated a well-seated valve, no paravalvular leak in all cases and a peak gradient of 12.7 mmHg, 14.8 mmHg and 17.7 mmHg in Cases 1, 2 and 3, respectively.

Conclusion

The Perceval prosthesis is an excellent choice for rAVR, as it can safely simplify challenging cases at risk of PPM and is an excellent valve-in-valve alternative to degenerated or infected Bentall valves with patent graft. The Perceval prosthesis can be well seated on the different structures of a degenerated bioprosthetic valve.