39. Sutureless AVR Experience in a Single Center: 11 Years of Use in 468 Patients
Bart Meuris, Delphine Szecel, Roxanne Eurlings, Filip Rega, Peter Verbrugghe
UZ Leuven, Leuven, Belgium
Invited Discussant: *Allan S. Stewart
Objective: Given the limited reimbursement of transcatheter aortic valve procedures (TAVR) in Belgium, a high number of elderly and high-risk patients are still referred for surgical aortic valve replacement (SAVR) in our center. All these patients are treated with a Perceval sutureless valve. Since our center participated in the 'first-in-man' trial with this valve in 2007, this series represents the longest available clinical follow-up (11y) with this sutureless technology.
Methods: We collected clinical and echocardiographic follow-up data in 468 consecutive patients who received Perceval at our institution between 2007 and 2017. The dataset represents an all-comers experience, including emergency cases. In 55% of cases, surgery was combined with CABG (39%), mitral valve repair or replacement (10%), or other procedures (6%). In isolated procedures, 64% were done minimally invasive using either ministernotomy of right anterior minithoracotomy.
Results: Mean age was 79y, mean EuroSCORE II was 5.0 (range 0.8 to 60) and mean STS score was 5.8 (range 0.7 to 36). Mean cross-clamp times for isolated and combined procedures were 38 and 79 minutes respectively. Observed all-cause 30-day mortality was 3.2% with an early stroke rate of 1.8%. Pacemaker implantation was needed in 7.9% of all patients. All-cause mortality at 1 and 2 years was 9.4% and 14.8% respectively. At the latest echocardiographic follow-up (mean 3y, range 1 to 11y), peak and mean gradients were 23 +/- 10mmHg and 13 +/- 6mmHg. Paravalvular leak (PVL) is absent in 94% of cases, 5% have trivial PVL (grade 0-1/4) and 1% has PVL grade 1-2/4. During follow-up, we explanted 4 valves for endocarditis, and none for structural valve degeneration (SVD). One case of SVD was diagnosed at 7y follow-up, but the patient refused reoperation.
Conclusions: Due to the limited reimbursement of TAVR in Belgium, we use sutureless valves predominantly in these elderly, intermediate- and high-risk patients, both in isolated AVR but evenly in combined procedures. The results regarding early stroke and mortality at both 30 days and 2y, are better than those reported in both the surgical as the transcatheter arms of large trials comparing TAVR and SAVR in comparable patient cohorts. The Perceval sutureless valve offers a stable, time-saving and safe surgical result, both in isolated as in combined procedures. We observe promising long-term durability given the current low incidence of SVD after 11 years of continued clinical use.