Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 28;12(19):6265.
doi: 10.3390/jcm12196265.

Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases

Giovanni Concistrè  1 , Tommaso Gasbarri  1 , Marcello Ravani  2 , Anees Al Jabri  2 , Giuseppe Trianni  2 , Giacomo Bianchi  1 , Rafik Margaryan  1 , Francesca Chiaramonti  1 , Michele Murzi  1 , Enkel Kallushi  1 , Egidio Varone  1 , Simone Simeoni  1 , Alessandro Leone  1 , Andrea Farneti  1 , Sergio Berti  2 , Marco Solinas  1
Affiliations

Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases

Giovanni Concistrè et al. J Clin Med. .

Abstract

Background: Sutureless aortic bioprostheses are increasingly being used to provide shorter cross-clamp time and facilitate minimally invasive aortic valve replacement. As the use of sutureless valves has increased over the past decade, we begin to encounter their degeneration. We describe clinical outcomes and technical aspects in patients with degenerated sutureless Perceval (CorCym, Italy) aortic bioprosthesis treated with valve-in-valve transcatheter aortic valve replacement (VIV-TAVR).

Methods: Between March 2011 and March 2023, 1310 patients underwent aortic valve replacement (AVR) with Perceval bioprosthesis implantation. Severe bioprosthesis degeneration treated with VIV-TAVR occurred in 32 patients with a mean of 6.4 ± 1.9 years (range: 2-10 years) after first implantation. Mean EuroSCORE II was 9.5 ± 6.4% (range: 1.9-35.1%).

Results: Thirty of thirty-two (94%) VIV-TAVR were performed via transfemoral and two (6%) via transapical approach. Vascular complications occurred in two patients (6%), and mean hospital stay was 4.6 ± 2.4 days. At mean follow-up of 16.7 ± 15.2 months (range: 1-50 months), survival was 100%, and mean transvalvular pressure gradient was 18.7 ± 5.3 mmHg.

Conclusion: VIV-TAVR is a useful option for degenerated Perceval and appears safe and effective. This procedure is associated with good clinical results and excellent hemodynamic performance in our largest single-center experience.

Keywords: aortic bioprosthesis degeneration; aortic valve replacement; sutureless aortic valve; transcatheter aortic valve.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preprocedural planning with ECG gated medium contrast CT scan. (A) Sizing of the landing zone (Perceval inflow ring) diameters, area and perimeter; (B) aortic root dimensions; (C) right coronary artery take off; (D) left coronary artery take off.
Figure 2
Figure 2
Crossing degenerated Perceval with AL catheter and straight tip guide wire.
Figure 3
Figure 3
Crimped THV proper positioning.
Figure 4
Figure 4
Soft predilatation and flossing.
Figure 5
Figure 5
Final result.
Figure 6
Figure 6
Radiological anatomy of Perceval. The Ni-Ti alloy radiopaque stent is clearly visible. (A) Fluoroscopic view; (B) CT scan long axis view; (C) CT scan short axis view.
Figure 7
Figure 7
A case of wrong Perceval crossing outside the outflow ring, laterally and then inside the inflow ring with impossibility to advance and deliver the THV.
Figure 8
Figure 8
Preprocedural CT scan shows the inflow ring of a degenerated Perceval; a certain level of eccentricity is clearly visible with a sort of rounded triangular shape. (A) Post VIV-TAVIR CT scan of the same prosthesis, we can appreciate a circumferential expansion with minor diameter passing from about 2.05 cm to about 2.3 cm (B).
Figure 9
Figure 9
(A) THV delivery is not correct; going too deep in the ventricle may lead to suboptimal THV hemodynamic and earlier degeneration. (B) Angiography shows the absence of a paravalvular leak despite a deep delivery.
Figure 10
Figure 10
Radiological markers in Perceval. (A) Fluoroscopic view; (B) CT scan long axis view; (C) CT scan short axis view.
See this image and copyright information in PMC

References

    1. Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., ErwinIII J.P., Guyton R.A., O’Gara P.T., Ruiz C.E., Skubas N.J., Sorajja P., et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014;63:2438–2488. - PubMed
    1. Vahanian A., Alfieri O., Andreotti F., Antunes M.J., Barón-Esquivias G., Baumgartner H., Borger M.A., Carrel T.P., De Bonis M., Evangelista A., et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur. J. Cardiothorac. Surg. 2012;42:S1–S44. - PubMed
    1. Goodney P.P., O’Connor G.T., Wennberg D.E., Birkmeyer J.D. Do hospitals with low mortality rates in coronary artery bypass also perform well in valve replacement? Ann. Thorac. Surg. 2003;76:1131–1136. doi: 10.1016/S0003-4975(03)00827-0. - DOI - PubMed
    1. Brown J.M., O’Brien S.M., Wu C., Sikora J.A., Griffith B.P., Gammie J.S. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: Changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J. Thorac. Cardiovasc. Surg. 2009;137:82–90. doi: 10.1016/j.jtcvs.2008.08.015. - DOI - PubMed
    1. Fischlein T., Meuris B., Hakim-Meibodi K., Misfeld M., Carrel T., Zembala M., Gaggianesi S., Madonna F., Laborde F., Asch F., et al. CAVALIER Trial Investigators. The sutureless aortic valve at 1 year: A large multicenter cohort study. J. Thorac. Cardiovasc. Surg. 2016;151:1617–1626.e4. doi: 10.1016/j.jtcvs.2015.12.064. - DOI - PubMed