Key result
Perceval sutureless valve matches conventional bioprostheses for 30-day mortality, but reduces postoperative kidney injury.
Why the study?
Does the Perceval sutureless aortic valve reduce mortality or morbidity compared to conventional stented bioprostheses in patients undergoing isolated aortic valve replacement?
Meta-Analysis (n=1,399)
Does the Perceval sutureless aortic valve reduce mortality or morbidity compared to conventional stented bioprostheses in patients undergoing isolated aortic valve replacement?
Odds Ratio: 0.99 (95% CI 0.52–1.88)
Absolute Event Rate: 2.8% vs 2.7%
p-value: p=0.98
The Perceval sutureless valve matches conventional bioprostheses for mortality outcomes but significantly shortens bypass times and lowers acute kidney injury risk, at the cost of higher pacemaker implantation rates.
Equivalence in mortality with lower kidney injury supports selective use in high-risk patients; extends pooled comparative data for sutureless valves.
Background Aortic stenosis is the most common valvular disease and has a dismal prognosis without surgical treatment. The aim of this meta‐analysis was to quantitatively assess the comparative effectiveness of the Perceval (LivaNova) valve versus conventional aortic bioprostheses. Methods and Results A total of 6 comparative studies were identified, including 639 and 760 patients who underwent, respectively, aortic valve replacement with the Perceval sutureless valve (P group) and with a conventional bioprosthesis (C group). Aortic cross‐clamping and cardiopulmonary bypass duration were significantly lower in the P group. No difference in postoperative mortality was shown for the P and C groups (2.8% versus 2.7%, respectively; odds ratio [OR]: 0.99 [95% confidence interval ( CI ), 0.52–1.88]; P =0.98). Incidence of postoperative renal failure was lower in the P group compared with the C group (2.7% versus 5.5%; OR: 0.45 [95% CI , 0.25–0.80]; P =0.007). Incidence of stroke (2.3% versus 1.7%; OR: 1.34 [95% CI , 0.56–3.21]; P =0.51) and paravalvular leak (3.1% versus 1.6%; OR : 2.52 [95% CI , 0.60–1.06]; P =0.21) was similar, whereas P group patients received fewer blood transfusions than C group patients (1.16±1.2 versus 2.13±2.2; mean difference: 0.99 [95% CI , −1.22 to −0.75]; P =0.001). The incidence of pacemaker implantation was higher in the P than the C group (7.9% versus 3.1%; OR : 2.45 [95% CI , 1.44–4.17]; P =0.001), whereas hemodynamic Perceval performance was better (transvalvular gradient 23.42±1.73 versus 22.8±1.86; mean difference: 0.90 [95% CI , 0.62–1.18]; P =0.001), even during follow‐up (10.98±5.7 versus 13.06±6.2; mean difference: −2.08 [95% CI , −3.96 to −0.21]; P =0.030). We found no difference in 1‐year mortality. Conclusions The Perceval bioprosthesis improves the postoperative course compared with conventional bioprostheses and is an option for high‐risk patients.
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Meco et al. (2018) conducted a meta-analysis in Aortic valve stenosis (n=1,399). Perceval sutureless aortic valve bioprosthesis vs. Conventional stented aortic bioprosthesis was evaluated on 30-day all-cause mortality (OR 0.99, 95% CI 0.52-1.88, p=0.98). The Perceval sutureless aortic valve showed no significant difference in 30-day all-cause mortality compared to conventional bioprostheses (OR 0.99, p=0.98), but lowered postoperative kidney injury.
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