Modified Implantation Technique of The Perceval Sutureless Aortic Valve

Ahmed Mashhour, Konstantin Zhigalov, Marcin Szczechowicz, Sabreen Mkalaluh, Irakli Gogia, Jerry Easo, Harald Eichstaedt, Jürgen Ennker, Alexander Weymann

Klinikum Oldenburg, Oldenburg, Germany

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

 Objectives. We present a modified implantation technique of the Perceval® sutureless

aortic valve that involves the usage of snuggers for the

guiding sutures during ballooning of the valve.

Methods. Between September 2016 and August 2017, 60 patients (age 70±9 years, 31

males) received a Perceval aortic valve. As in the standard technique, we place the three guiding sutures

at the nadirs of each sinus and pass them through the holding loops at the valve prosthesis.

Then, both limbs of each guiding suture are pulled through a snugger, which is fixed with a

Pean-clamp on its distal end. The valve is then descended into the aortic root. Afterwards,

the snuggers are tightened, so that the valve is fixed in the correct position. After standard

valve release and ballooning, correct positioning of the valve is re-checked, the snuggers are

released and the guiding sutures removed. The procedure is then continued in the standard

manner.

Results. 30 patients (50%) received a

total of 34 concomitant procedures; nine (26.5%) other valve procedures, 15 (44%) coronary

bypass grafting, nine (26.5%) rhythm surgeries and one (3%) left ventricular assist device

implantation. The implanted valves were size XL (23 patients, 38.3%), L (23 patients,

38.3%), M (11 patients, 18.3%) and S (3 patients, 5%). Nine patients (15%) had endocarditis

as primary diagnosis. Aortic cross clamp time was 48±19 minutes and there was 100%

primarily successful valve implantation. We had three intrahospital mortalities (5%), and one permanent

neurological insult (1.6%). There were no paravalvular leaks or valve dislocations.

Conclusion. The maintenance of correct valve position during its release and ballooning is a

vital step during Perceval implantation. Our technique allows a simple and secure fixation of

the valve and a better view during its release and ballooning. Using the snuggers allows an

adequate valve fixation in the axial plane and prevents its rotation around the holder. This

minimizes the chance for errors caused by valve dislocation during implantation.