Membranous ventricular septum aneurysm (MVSA) is extremely rare, especially when coexisting with aortic stenosis (AS), and reports regarding the available treatment for MVSA with AS are limited. Aortic valve replacement (AVR) can be challenging because of anatomical reasons. In this case report, a patient with MVSA and severe AS was treated with AVR with the sutureless Perceval bioprosthesis. After implantation, no paravalvular leakage was detected in echocardiography, and no other postoperative complications were observed. Postoperative electrocardiography-gated computed tomography revealed no contrast enhancement for MVSA. The MVSA was closed by the Perceval bioprosthetic valve. Thus, patients with simultaneous MVSA and AS may be effectively treated with AVR using a Perceval bioprosthesis.

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http://dx.doi.org/10.1177/1556984520984256DOI Listing

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Article Synopsis
  • Aortic valve replacement (AVR) has seen an increased use of the Perceval sutureless bioprosthesis, which shows promising safety and reliability in both short- and mid-term outcomes, with some long-term data emerging.
  • An updated systematic review of studies from 2015 to 2024 analyzed long-term outcomes of 5,221 patients with Perceval implants, revealing a long-term survival rate between 64.8% to 87.9% and low rates of complications such as structural valve degeneration and significant leaks.
  • Despite limited data on sutureless bioprostheses, the encouraging results from existing studies suggest that Perceval could provide
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Introduction: The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.

Aim: To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).

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Findings in the present case underscore the potential of sutureless aortic valve utilization in patients with prior prosthetic root replacement, thereby obviating the need for high-risk procedures such as replacing a prosthetic root or reimplanting a coronary artery. A 75-year-old male who had undergone a Bio-Bentall operation with a bioprosthetic Trifecta valve for aortic regurgitation and annuloaortic ectasia eight years prior presented with symptoms of heart failure, notably dyspnoea, attributed to prosthetic valve dysfunction. Although a transcatheter aortic valve implant is often recommended, it was deemed unsuitable in this case due to a history of type B aortic dissection.

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Article Synopsis
  • Valve-in-Valve (VIV) transcatheter aortic valve replacement (TAVR) shows promise for treating malfunctioning Perceval surgical valves, but data on its effectiveness are limited.
  • A study analyzed 57 patients from various reports, with most being women around 76 years old; results showed a reduction in heart gradient and a low complication rate (15.7%).
  • VIV-TAVR can be done safely with specific valve technologies, but should only be performed by skilled operators familiar with both TAVR and VIV procedures.*
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: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods.

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