Key result
Perceval sutureless AVR yields ~7.8 years median survival, with younger age predicting structural valve deterioration.
Why the study?
Data regarding long-term outcomes and prosthesis durability following sutureless aortic valve replacement are still lacking.
Cohort (n=547)
No
Sutureless aortic valve replacement with the Perceval valve provides reliable durability over 10 years, with younger age at implant being the primary risk factor for structural valve deterioration.
Supports Perceval durability in older patients; younger age link to SVD leaves open optimal selection in younger cohorts.
OBJECTIVES: Aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. METHODS: All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our centre between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. RESULTS: Study population consisted of 547 patients: the mean age was 76.4 (5.2) years, 51% were female and the mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years [95% confidence interval (CI) = 6.9-8.6]. Risk factor analysis identified age [hazard ratio (HR) 1.06, 95% CI 1.03-1.11; P < 0.001), EuroSCORE II (HR 1.08, 1.02-1.13; P < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4-4.4; P = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58-17.6; P < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per 1 year and for EuroSCORE II is 1 percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of whom 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82-0.95; P < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. CONCLUSIONS: The sutureless valve represents a reliable bioprosthesis for aortic valve replacement in patients with a 10-year life expectancy. Younger age at the time of implant is the only factor associated with the risk of long-term SVD.
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Pollari et al. (2022) conducted a cohort in Severe aortic valve stenosis (n=547). Sutureless aortic valve replacement (Su-AVR) with the Perceval valve was evaluated on Median survival (years) (95% CI 6.9-8.6). Sutureless aortic valve replacement with the Perceval valve demonstrated a median survival of 7.76 years (95% CI 6.9-8.6), with younger age predicting structural valve deterioration.
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