Clinical outcomes and haemodynamic evolution following Perceval sutureless aortic valve implantation in high-risk aortic stenosis patients.

Abstract

Background: Sutureless aortic valve replacement (AVR) has been recognised as a potential option in the management of High-risk patients, characterised by reduced procedural times and satisfactory haemodynamic results. However, mid-term results of valve-related outcomes are scarce. This study aimed to investigate clinical, echocardiographic, and valve-related outcomes of high-risk patients undergoing Perceval sutureless AVR.

Methods: The current retrospective, single-centre study included 50 consecutive high-risk patients who had isolated Perceval sutureless AVR. The time period was between January 2023 and December 2024. The primary endpoint was one-year valve-related survival. The secondary endpoints included echocardiographic performance, paravalvular leakage (PVL), patient-prosthesis mismatch (PPM), and the need for pacemaker implantation. Transthoracic echocardiography was performed at discharge and follow-up.

Results: Complete echocardiographic follow-up at 12 months was available for 44 patients (88%). The transvalvular gradient significantly decreased from 46.8 ± 11.2 to 12.4 ± 3.6 at discharge and remained stable at 12 months (12.1 ± 3.5; p < 0.001). The indexed effective orifice area increased from 0.58 ± 0.09 to 1.10 ± 0.16 cm²/m² at 12 months. No case of severe patient-prosthesis mismatch (PPM) was noted, but moderate PPM occurred in 12%. PVL was trivial or mild in all patients. Permanent pacemaker implantation was necessary in 20%, all within the index hospitalisation period, without any recovery of native conduction at follow-up. Valve-related survival at 12 months was 94%, with death from non-valve-related causes.

Conclusion: Sutureless Perceval aortic valve implantation has been shown to provide excellent clinical and haemodynamic results at midterm follow-up in high-risk patients with low rates of valve-related complications, PVL, and patient prosthesis mismatch.