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Meta-Analysis
. 2018 Feb 16;7(4):e006091.
doi: 10.1161/JAHA.117.006091.

Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta-Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement

Massimo Meco  1 , Andrea Montisci  2 , Antonio Miceli  1 , Paolo Panisi  3 , Francesco Donatelli  1   4 , Silvia Cirri  1 , Matteo Ferrarini  1 , Antonio Lio  1 , Mattia Glauber  1
Affiliations
Meta-Analysis

Sutureless Perceval Aortic Valve Versus Conventional Stented Bioprostheses: Meta-Analysis of Postoperative and Midterm Results in Isolated Aortic Valve Replacement

Massimo Meco et al. J Am Heart Assoc. .

Abstract

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.

Keywords: Perceval valve; Sutureless bioprothesis; aortic stenosis; prosthetic heart valve.

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Figures

Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Forrest plot of the odds ratio or mean difference of (A) acute kidney injury and (B) length of mechanical ventilation after Perceval valve vs conventional bioprosthesis implantation. CI indicates confidence interval; IV, inverse variance; M‐H, Mantel–Haenszel.
Figure 3
Figure 3
Forrest plot of the odds ratio or mean difference of (A) postoperative pacemaker implantation, (B) paravalvular leak, and (C) mean transvalvular gradient after Perceval valve vs conventional bioprosthesis implantation. CI indicates confidence interval; IV, inverse variance; M‐H, Mantel–Haenszel.
Figure 4
Figure 4
Forrest plot of the Peto odds ratio of (A) postoperative mortality, of (B) 1‐year survival. CI indicates confidence interval; O‐E, observed–expected events; V, variance; Exp, exponential
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