Is Sub-Commissural Annuloplasty a Safe Adjunct to Sutureless Perceval-S Aortic Valve Implantation?

Background: Sutureless bioprosthesis aortic valves simplify surgery for aortic valve replacement (AVR) but some unexpected anatomical features of the recipients aortic annulus might preclude anchoring and lead to a paravalvular leak. Sub-Commissural Annuloplasty (SCAP) has been sporadically proposed to secure implantation under these circumstances. This study evaluated whether SCAP affects early postoperative outcomes and follow-up after sutureless Perceval-S implantation. Methods: We included all elective patients who underwent AVR (isolated or combined with coronary bypass) with the Perceval-S valve from March 2016 to August 2019. SCAP was performed each time the surgeon deemed it useful to improve anchoring. Results: One hundred and three patients were included. The mean age was 73.9±7.2 years and 36 (35%) were women. SCAP was performed in 34 (33%) patients, significantly more frequently in patients with large aortic annulus or bicuspid aortic valve. Perceval-S implantation was successful in 100 (97%) patients. Thirty-day mortality was 2% (n=2), of which one was related to the procedure. There was no significant difference in the incidence of postoperative conduction disorders between patients with and without SCAP (respectively, 3 [9%] vs 7 [10%], p=1.0). At one-year follow-up, no more than trivial paravalvular leak was noted in both groups, and peak and mean gradients were similar in patients with SCAP than in those without (19.1±8.3 vs 17.9±7.1 mmHg, p=0.53 and 10.7±5.0 vs 10.0±3.9 mmHg, p=0.59, respectively). Conclusions: SCAP is a safe, simple and reproducible technique that might facilitate Perceval-S aortic valve implantation in specific situations.