Is sub-commissural annuloplasty a safe adjunct to sutureless Perceval-S
aortic valve implantation ?
Abstract
Background: Sutureless bioprothesis aortic valves simplify surgery for
aortic valve replacement (AVR) but some anatomical features of the
recipients aortic annulus might preclude anchoring and lead to
paravalvular leak. Sub-commissural annuloplasty (SCAP) has been
sporadically proposed to secure implantation under these circumstances.
This study evaluated whether SCAP affects early postoperative outcomes
after sutureless Perceval-S implantation. Methods: We included all
patients who underwent AVR (isolated or combined with coronary bypass)
with the Perceval-S valve from March 2016 to August 2019. SCAP was
performed each time the surgeon deemed it useful to improve anchoring,
including after primary implantation failure. Results: One hundred and
three patients were included. Mean age was 73.9±7.2 years and 36(35%)
were women. SCAP was performed in 34(33%) patients, significantly more
frequently in patients with large aortic annulus or bicuspid aortic
valve. Perceval-S implantation was successful in 100(97%) patients and
SCAP allowed successful redeployment of the same Perceval S valve in
4(28%) of first implantation failures. Thirty-day mortality was 2%
(n=2), of which one was related to the procedure. There was no
significant difference in the incidence of postoperative conduction
disorders between patients with and without SCAP (respectively,
3[9%] vs 7[10%], p=1.0). More than trivial paravalvular leak
was noted in 1(1%) patient without SCAP. Postoperative peak and mean
pressure gradients were lower in patients with than in those without
SCAP (respectively, 19.0±7.9 mmHg vs 23.1±7.0 mmHg, p=0.001; and
10.4±4.1 versus 12.6±3.7 mmHg, p=0.001). Conclusions: SCAP is a safe,
simple and reproducible technique that might facilitate Perceval-S
aortic valve implantation.