eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2024
vol. 21
 
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abstract:
Original paper

Perceval sutureless bioprosthesis versus Trifecta sutured bioprosthesis for aortic valve replacement: immediate results of the Perfecta study

Paolo Nardi
1
,
Claudia Altieri
2
,
Calogera Pisano
1
,
Dario Buioni
1
,
Federico Agneni
1
,
Giorgia Grizzi
3
,
Martin Dakli
1
,
Alessandro Cristian Salvati
1
,
Mattia Scognamiglio
1
,
Carlo Bassano
1
,
Giovanni Ruvolo
1

  1. Division of Cardiac Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
  2. Cardiology Unit, Division of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy
  3. Graduated Technical Cardio-circulatory Pathophysiology and Cardiovascular Perfusion, Tor Vergata University of Rome, Rome, Italy
Kardiochirurgia i Torakochirurgia Polska 2024; 21 (3): 153-161
DOI: https://doi.org/10.5114/kitp.2024.143499
Online publish date: 2024/09/25
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Introduction
The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.

Aim
To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).

Material and methods
Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively.

Results
Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively (p = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients (p = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications.

Conclusions
Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.

keywords:

surgical aortic valve replacement, sutureless prostheses, third-generation sutured biological prostheses
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