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Review
. 2025 Aug 9;20(1):331.
doi: 10.1186/s13019-025-03369-y.

Perceval prosthesis implantation into challenging degenerated aortic valves: a literature review and case series

Pouya Nezafati  1 , Chimezi Uchime  2 , Sumit Yadav  3   4
Affiliations
Review

Perceval prosthesis implantation into challenging degenerated aortic valves: a literature review and case series

Pouya Nezafati et al. J Cardiothorac Surg. .

Abstract

Background: The Perceval Sutureless prosthesis can increase the effective orifice area (EOA) and reduce the chance of prosthesis-patient mismatch (PPM). This report presents three patients with challenging degenerated bioprosthetic valves undergoing redo aortic valve replacement (rAVR) using the Perceval (LivaNova, London, UK) prosthesis from a cohort of more than 300 performed cases and a review of the literature on the management of challenging degenerated valves.

Methods: Case 1: Degenerated 23 mm Trifecta with the valve cage densely adherent to the annulus. Cage with sewing ring were excised and annulus sized to a large Perceval valve. Case 2: Degenerated 29 mm Epic from a Bentall's procedure. Calcified and rigid prosthetic leaflets as well as stent posts were excised and XL Perceval implanted. Case 3: Degenerated 27 mm Epic with signs of endocarditis from a history of Bentall's procedure. Three calcified leaflets of the Epic valve were completely excised. The orifice accepted a medium Perceval.

Results: The total Cardiopulmonary Bypass (CPB) and aortic cross clamp (ACC) times (in minutes) were 99.76, 117.68 and 143.99 in Cases 1, 2 and 3, respectively. Moreover, post-implantation transesophageal echocardiogram (TOE) demonstrated a well-seated valve, no paravalvular leak in all cases and a peak gradient of 12.7 mmHg, 14.8 mmHg and 17.7 mmHg in Cases 1, 2 and 3, respectively.

Conclusion: The Perceval prosthesis is an excellent choice for rAVR, as it can safely simplify challenging cases at risk of PPM and is an excellent valve-in-valve alternative to degenerated or infected Bentall valves with patent graft. The Perceval prosthesis can be well seated on the different structures of a degenerated bioprosthetic valve.

Keywords: Aortic valve replacement; Degenerated aortic valve; Perceval.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from all participants. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(a) Stepwise complete excision of Trifecta valve (b) Large Perceval Implanted onto the annulus
Fig. 2
Fig. 2
(a) Excision of Epic stent posts from a Valsalva graft (b) X-Large Perceval implanted onto the Valsalva graft
Fig. 3
Fig. 3
(a) Excision of Epic Leaflets and placement of stay sutures (b) Implantation of Medium Perceval onto Stent posts
See this image and copyright information in PMC

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