Objective: The implantation technique of sutureless aortic bioprostheses shortens aortic crossclamp and cardiopulmonary by-pass times, minimizes aortic annulus manipulation, and provides good hemodynamics. These features might benefit the most patients with infective endocarditis.
Objectives: This study aims to analyze the mid-term clinical and hemodynamic outcomes of treating complicated aortic infective endocarditis with Perceval (Livanova) bioprostheses.
Methods: Since January 2009, over 1300 consecutive patients underwent an aortic valve replacement with a Perceval bioprosthesis. Among them, between July 2014 and June 2022, 36 patients were operated on because of an aortic infective endocarditis.
Results: Median euroSCORE I was 34% (rank, 10.5%-85%) and median euroSCORE II was 15.8% (rank, 5.5%-79.2%). Preoperative echocardiographic evaluation revealed perivalvular extension in almost 60% of the cases. All surgeries were performed on an urgent basis. The most frequently implanted prosthetic size was L (41.7%), followed by size XL (27.8%), size M (25%) and size S (5.5%). An associated procedure was necessary in 50% of the patients. Mean CPB and AXC times were 72.6±36.4 and 48.8±26.5 minutes, respectively. Thirty-day mortality was 13.9%. Cumulative follow-up was 852.1 patient-months. Long-term survival at 1 year and 5 years was 72.1% and 61.4%, respectively. There were no cases of endocarditis relapse or new IE during the follow-up.
Conclusions: The Perceval sutureless aortic bioprosthesis provides an excellent alternative for surgical treatment of challenging and time consuming complicated both native and prosthetic aortic IE. This sutureless valve seems to allow a rapid, reproducible, and technically feasible repair, shortening both aortic cross-clamp and cardiopulmonary by-pass times.

Keywords:Infective endocarditis; Sutureless valve; Aortic valve replacement; Perceval

Abbreviations:AXC: Aortic Cross-Clamp; CPB: Cardiopulmonary Bypass; ICU: Intensive Care Unit; IE: Infective Endocarditis; NVE: Native Valve Endocarditis; PVE: Prosthetic Valve Endocarditis; SU-AVR: Sutureless Aortic Valve Replacement; TEE: Transesophageal Echocardiogram