Key result
The sutureless Perceval aortic valve was associated with significantly lower median ischemic time (33 vs 60.5; p<0.001) and reduced hospital stay (MD -1.3; 95% CI -2.3 to -0.29; p=0.012) compared to conventional bioprostheses.
Why the study?
High-risk patients are presenting for aortic valve replacement and sutureless valves may decrease operative risk, prompting comparison of short-term and one-year outcomes against bioprosthetic valves.
Does the sutureless Perceval valve improve short-term and one-year outcomes compared to conventional bioprosthesis in patients undergoing elective aortic valve replacement?
Cohort (n=75)
No
Does the sutureless Perceval valve improve short-term and one-year outcomes compared to conventional bioprosthesis in patients undergoing elective aortic valve replacement?
Mean Difference: -1.3 (95% CI -2.3–-0.29)
p-value: p=0.012
The sutureless Perceval valve significantly reduces ischemic time and postoperative hospital stay compared to conventional bioprosthesis in patients undergoing elective aortic valve replacement.
Shorter ischemic times and hospital stay may benefit select AVR patients; leaves open need for RCTs to confirm outcomes.
Background: High-risk patients are currently presenting for aortic valve replacement (AVR). Sutureless valves may decrease the operative risk in those patients. The objective of this study was to compare the short-term and one-year follow-up results of the sutureless Perceval valve versus bioprosthetic aortic valve. Methods: The data of patients who underwent elective AVR with bioprosthesis were collected From March 2012 to March 2017. The patients were divided into two groups; group 1 included the patients who had a sutureless aortic valve (Perceval) (n= 25; 3.57% of total AVR patients), and group 2 included patients who had conventional bioprosthesis (n= 50; 7.1% of total AVR patients). Results: The median age of patients in group 1 was 67 years (25th- 75th percentiles; 64-71), and in group 2 was 66 years (25th- 75th percentiles: 63 to 69). There is no significant difference in the patients’ comorbidities between the two groups. The median duration of the ischemic time was significantly lower in group 1 (33 (25th- 75th percentiles: 32- 35) vs. 60.5 (58- 66), respectively; p< 0.001). Perceval valve was used more commonly in patients who had minimally invasive AVR (n= 21 (84%) in group 1 vs. 11 (22%) in group 2; p<0.001). Postoperative complications were comparable between both groups. The early paravalvular leak was non-significantly higher in group 1 (12% vs. 2%; p= 0105). The mean postoperative gradient was lower in group 1 (7 (7-9) vs. 10 (8-12) mmHg; p<0.001). The changes in valvular gradient were not significantly different between both groups (p= 0.5). The hospital stay was lower in patients received Perceval valve (Coefficient: -1.3; 95% Cl: -2.3- -0.29; p=0.012) Conclusion: Sutureless aortic valve (Perceval) is a new surgical technique for AVR, with potential advantages of reducing cross-clamp time and a subsequent reduction in myocardial ischemia, duration of cardiopulmonary bypass, and maintaining satisfactory hemodynamic outcomes through reducing patient prosthesis mismatch. All these advantages could help in decreasing postoperative hospital stay.
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Mohamed Fouly (2020) conducted a cohort in Aortic valve replacement (n=75). Sutureless aortic valve (Perceval) vs. Conventional bioprosthesis was evaluated on Hospital stay (Coefficient -1.3, 95% CI -2.3 to -0.29, p=0.012). The sutureless Perceval aortic valve was associated with significantly lower median ischemic time (33 vs 60.5; p<0.001) and reduced hospital stay (MD -1.3; 95% CI -2.3 to -0.29; p=0.012) compared to conventional bioprostheses.
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