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DOI: 10.1055/s-0037-1598710
The Fluttering Cusps of the Perceval: A Transthoracic and Transesophageal Echocardiography Study
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Sutureless aortic prostheses are gaining popularity due to the substantial reduction of cross clamp time while presenting reliable hemodynamic features. In this study, we report our initial experiences with the Perceval bioprosthesis (Sorin Biomedica Cardio Srl, Sallugia, Italy).
Methods: Between August 2014 and July 2016, a total of 93 patients (60% female) with a mean age of 77.6 years and mean body mass index (BMI) of 28.1 ± 4.5 kg/m2 underwent a non-emergent aortic valve replacement (AVR) via mini-sternotomy for degenerative aortic valve stenosis or combined vitium.
Transthoracic echocardiography was performed in all patients prior to discharge for detection of paravalvular leakage (PVL), measurement of gradients, acceleration-time (AT), ejection time (ET), Doppler velocity-indices (DVI, Vmax LVOT/Vmax AV) and effective orifice area indices to BSA (EOAI). Data was collected retrospectively from our hospital databases.
Results: One patient died during 30 POD, all other patients survived surgery without any major complications.
The mean EOAI was 0.91 ± 0.12 cm2/m2. The overall mean pressure gradients were in normal range in all groups (Table 1). AT and DVI were also within normal range, according to ASE/EAE guidelines. Twelve patients (2 with size S, 6 with size M and 4 with size L Perceval) had significantly high mean pressure gradients (31 ± 6 mm Hg), but the AT (80 ± 10 ms) and DVI (0.26 ± 0.4) were in normal range. TOE was performed in these 12 patients. In TOE 2D mode, there was remarkable fluttering of the cusps of the Perceval. M-Mode revealed that the fluttering of the cusps lasts ~60% of the ET leading to a functional stenosis and high gradients caused by turbulence, because the cusps almost completely close during fluttering. Two patients who presented the phenomena had their AVR 2014, while the TOE control after one year demonstrated the same findings.
Conclusion: Further in vitro studies are required to analyze the fluttering phenomena of the Perceval, and long- term follow-up results are necessary to evaluate whether this fluttering phenomena results in early damage of the cusps.