Livanova Perceval prosthesis to treat elderly frail patients: immediate and short-term results

Background: High risk older patients needing surgery for aortic valve stenosis may benefit from low-impact procedures. Suture less prostheses allow a more expedite procedure and might induce better clinical results. Aim of this study was to compare early and short-term clinical performance of Livanova Perceval in a frail patient’s population. Methods: From May 2012 to January 2014 twenty one patients (mean age 80.6 ± 4.3 years), received a Sorin Perceval STM (Group 1). Forty three patients treated with conventional AVR were selected as a control group (mean age 79.1 ± 3.3 years) (Group 2). The mean Logistic Euro score was 15.5% ± 7.3 in Group 1 and 14.7% ± 6.1 in Group 2; 14 patients (66%) of Group 1 and 26 patients (60%) of Group 2 were in NYHA functional class III/IV. Results: The observed 30 days mortality rate was zero in Group 1 and 9% in Group 2 (p ns). The mean cross-clamp and cardiopulmonary bypass time were significantly lower in Group 1 for isolated AVR (31.3 ± 4.6 vs. 45.6 ± 10.3 minutes p<0.0001 and 45.2 ± 6.6 vs. 59.1 ± 10.6 p<0.0001). In Group 1 there was no evidence of paraprosthesis leak, myocardial infarction or acute kidney injury and the postoperative hospital stay was 7.2 ± 2.4 days. The need of pacemaker implantation was significantly higher in Group 1. At 24 months follow up, the overall survival was 89.1 ± 11% in Group 1 vs. 83.6 ± 16.4% in Group 2 (pns) and freedom from adverse events was 84 ± 16% in Group 1 vs. 65.2 ± 34.8% in Group 2 (pns). Conclusions: The Livanova Perceval bioprosthesis seems to be an excellent option for elderly patients needing aortic valve replacement at increased risk for surgery. The incidence of early AV block represents the only relevant drawback of this device.