Perceval prosthetic valve endocarditis occurs at rates similar to conventional valves but frequently causes early mechanical instability and perivalvular extension requiring early surgery.
Endocarditis in Perceval sutureless valves presents unique diagnostic challenges requiring multimodality imaging and often necessitates early surgical intervention due to mechanical instability.
Sutureless aortic bioprostheses have become an established alternative for surgical aortic valve replacement, particularly in elderly and high-risk patients. The Perceval (Livanova) valve, the most widely studied sutureless device, offers favorable hemodynamic performance and reduced operative times but introduces specific challenges when prosthetic valve endocarditis (PVE) occurs. Although the incidence of Perceval PVE is low and comparable to that of conventional bioprostheses, this complication is associated with substantial morbidity and mortality. Diagnosis is often complex due to acoustic shadowing on echocardiography, making multimodality imaging with transesophageal echocardiography, cardiac computed tomography, and 18F-FDG PET/CT essential. Microbiological profiles resemble those of other biological prostheses, but perivalvular extension and early mechanical instability are frequent. Management follows general PVE principles but often requires early surgical intervention because of the valve’s reliance on radial fixation. This review summarizes current evidence on epidemiology, microbiology, diagnostic strategies, treatment, and prognosis of endocarditis involving the Perceval valve, and identifies areas for future research.
Rello et al. (2026) studied this question. Perceval prosthetic valve endocarditis occurs at rates similar to conventional valves but frequently causes early mechanical instability and perivalvular extension requiring early surgery.