Early Structural Deterioration of a Sutureless Bioprosthetic Aortic Valve

Abstract

Sutureless bioprosthetic valves such as the Sorin Perceval S valve (SPV) have been used in patients with aortic stenosis that require surgical aortic valve replacement (SAVR). These prostheses have been marketed on the basis of their rapid implantation techniques with avoidance of sutures and reduced aortic cross-clamp times. We report a case of an early failure of a SPV nearly 4 years after implantation in a 58-year-old woman who was low-risk. While the patient's symptoms initially improved with SAVR with a sutureless bioprosthetic valve, they progressively worsened as the valve degraded, and the leaflets became increasingly calcified and stenotic ultimately, requiring reoperative SAVR with a St. Jude mechanical valve. This case raises the issue of the lack of much-needed data describing the long-term durability and hemodynamic performance of these valves, particularly in a low-risk patient with excellent functional status. We hope to shed further insight into the lack of long-term studies on patients with SPV to assess their longevity and long-term effectiveness, as well as elucidation of possible prevention and monitoring of these potential complications. The use of newer generation prostheses, although attractive for their ease of implantation, potentially carries higher long-term risk due to shorter durability leading to reintervention to address valve deterioration. This is especially true in low-risk patients who are young and active. Cardiology and cardiothoracic surgery societies need to develop a universal registry with follow-up of all valves in order to track and study the durability of these valves, and to evaluate for incidence of known and potential complications.

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis

“…This finding questions the reliability of Perceval valve, especially for the younger population and patients with low-risk operative profiles. [36][37][38][39] Previous branch block or atrioventricular block, age, and larger valve annulus size and calcifications are risk factors for pacemaker implantation after AVR. [40][41][42][43] Surgical implantation technique may also contribute to atrioventricular conduction disorders.…”

Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations

“…In previous reports, structural valve deterioration was observed postoperatively ranging from very early (5 days) to late postoperative period (5 years), primarily due to leaflet calcification and/or stent creep. 119–122 …”

“…In previous reports, structural valve deterioration was observed postoperatively ranging from very early (5 days) to late postoperative period (5 years), primarily due to leaflet calcification and/or stent creep. [119][120][121][122] Regarding re-intervention to failed SRDV prosthesis, conventional open surgery should be considered as an option for reoperation unless there are high-risk factors including resternotomy after coronary artery bypass grafting. Valve-in -valve TAVR may be an alternative option for these cases with similar operative outcomes to open reoperation.…”

New tools in minimal invasive aortic valve surgery: case report

“…This is especially true in low-risk patients who are younger and still active. These patients are likely better served with the timetested prostheses with well-known durability and freedom from structural deterioration (17).…”