Key result
The Perceval valve yielded lower postoperative transvalvular pressure gradients (15 vs. 17 mmHg, p=0.002) but higher new pacemaker implantations (18.9% vs. 7.1%, p=0.005) than Perimount valves.
Why the study?
The Perceval valve facilitates minimally invasive surgery and shortens operative times, but its clinical and hemodynamic performances compared to well-established Carpentier-Edwards Perimount and Perimount Magna Ease valves warranted evaluation.
Does the Perceval sutureless aortic valve improve early hemodynamic and clinical outcomes compared to Perimount valves in patients undergoing aortic valve replacement?
Cohort (n=423)
No
Does the Perceval sutureless aortic valve improve early hemodynamic and clinical outcomes compared to Perimount valves in patients undergoing aortic valve replacement?
Absolute Event Rate: 15% vs 17%
p-value: p=0.002
The Perceval sutureless aortic valve offers lower postoperative transvalvular gradients and shorter operating times compared to Perimount valves, though it carries a higher risk of pacemaker implantation that may be mitigated by avoiding oversizing.
Trade-off of lower gradients for higher pacemaker risk with Perceval; observational data leaves open net benefit pending RCTs.
Objectives The Perceval valve was shown to facilitate minimal-invasive operations and shorten operative times. We aimed to compare the early results of the Perceval valve to those of well-established valves, namely the Carpentier–Edwards Perimount and Perimount Magna Ease valve protheses, in terms of their clinical and hemodynamic performances. Methods This is a single-center, retrospective, observational cohort study. For every patient operated with a Perceval valve, the last patient before and the next following patient receiving a Perimount valve was included in a control group leading to a 2:1 ratio (Perimount:Perceval). A propensity score matching was used and a subgroup analysis was performed to compare early and late Perceval patients as the sizing technique was changed over time. Results From November 2013 to November 2017, 423 patients were identified. These included 141 consecutive patients receiving a Perceval valve through a full- or a hemi-sternotomy. In addition, 282 patients receiving a Perimount or a Magna Ease valve were enrolled. After propensity score matching, 127 matched patients were compared. Operating times were shorter and postoperative transvalvular pressure gradients were lower in the Perceval group (15 vs. 17 mmHg, p = 0.002). There was no difference in mortality and stroke rates. The incidence of new pacemaker implantations was higher in the Perceval group (7.1 vs. 18.9%, p = 0.005), mainly due to a very high incidence in the early phase of our Perceval experience prior to a change in the Perceval implantation technique. Subgroup analysis showed significantly better results in the late Perceval group. Conclusion Surgical outcome was good in both groups. The Perceval valve exhibited lower postoperative gradients, and the need for pacemaker implantation was higher and can be reduced by avoiding oversizing.
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Kueri et al. (2022) conducted a cohort in Aortic valve replacement (n=423). Perceval sutureless aortic valve vs. Carpentier-Edwards Perimount and Perimount Magna Ease valves was evaluated on postoperative transvalvular pressure gradients (p=0.002). The Perceval valve yielded lower postoperative transvalvular pressure gradients (15 vs. 17 mmHg, p=0.002) but higher new pacemaker implantations (18.9% vs. 7.1%, p=0.005) than Perimount valves.
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