Single center, multi-surgeon experience with a sutureless rapid
deployment aortic valve prosthesis: A clinical and economic analysis in
the United States
Background The Perceval S is a sutureless, rapid deployment, bovine
pericardial aortic prosthesis on a nitinol stent, which has limited data
on outcomes and cost from the United States. Methods We performed a
retrospective review of Perceval S implantation at a single center
between 2015 and 2018. After exclusion criteria, we compared 262
patients who underwent sutureless aortic valve (SLV) implantation with
394 patients who underwent standard sutured aortic valves (SAVR).
Hospital cost data was reviewed, and risk adjustment, done by propensity
score and inverse probability weighting, was used to compare outcomes.
Results The SLV group was older, had more females, and had a higher
proportion of multicomponent operations. For isolated AVR, partial upper
hemisternotomy was more frequent in SLV. The median cardiopulmonary
bypass and cross clamp times for isolated SLV were significantly lower
than SAVR. SLV had a risk-adjusted 11.3% permanent pacemaker (PPM) rate
vs 6.1% in SAVR (p=0.016). There were no differences in other
postoperative complications (postoperative atrial fibrillation, stroke,
renal failure, prolonged ventilation; P>.05 for all).
Mortality at any time did not differ between groups. Median hospital
costs were higher in the SLV group, likely due to permanent pacemaker
rate leading to longer length of stay. Conclusion Sutureless tissue
aortic valves can be used safely with lower cardiopulmonary bypass and
clamp times than sutured prostheses and facilitate use of minimally
invasive approaches with cost neutrality. This valve may be advantageous
in older, higher risk patients requiring complex operations.