The impact of perceval sutureless aortic valve in multiple valve surgery: implications of short- and mid-term outcomes-a propensity score matched study

Abstract

Background: Sutureless aortic valve replacement (S-AVR) is a surgical alternative to conventional aortic valve replacement (C-AVR), recognized for its efficacy and clinical superiority in the treatment of valvular disease. Its use is gradually increasing not only in single-valve procedures but also in multiple valve surgeries. This study aimed to evaluate our experience with the Perceval S-AVR combined with mitral and tricuspid valve surgery such as multiple valve surgery, focusing on the clinical outcomes and operative time. Methods: Between January 2017 and December 2022, 141 patients underwent surgical aortic valve replacement (AVR) using the bioprosthetic aortic valve at our institution. Of them, 42 patients (29.8%) underwent S-AVR with multivalve surgery. After 1:1 propensity score matching, 42 patients were selected as study subjects in each group. The primary endpoints were 30-day and follow-up mortality and major valve-related adverse events, such as structural valve dysfunction, valve thrombus, endocarditis, stroke, re-intervention, and pacemaker implantation. Results: In matched cohort, the mean age 74.3 +/- 4.2 and 74.2 +/- 6.2 years in C-AVR and S-AVR groups, respectively. The in-hospital mortality rates were 2.4% and 0% (P>0.999), and follow-up mortality rates were 4.8% and 7.1% (P>0.99) in C-AVR and S-AVR groups, respectively. Paravalvular leakage and abnormal pressure acceleration were absent in both the groups, and the incidence of postoperative valve-related adverse events did not vary between the groups. The operation time, including for the mitral valve, tricuspid valve, and arrhythmia surgeries, was significantly shorter in the S-AVR group after matching (mean cardiopulmonary bypass time: 132.52 +/- 39.20 vs. 115.50 +/- 25.70 minutes, P=0.001; mean aortic cross clamp time: 100.90 +/- 32.12 vs. 80.38 +/- 18.81 minutes, P<0.001). Conclusions: S-AVR may be considered a viable option in cases requiring multiple valve surgery, as it can reduce operation time without compromising clinical outcomes.