Single center, multi-surgeon experience with a sutureless rapid deployment aortic valve prosthesis: A clinical and economic analysis in the United States

Background: The Perceval S is a sutureless, rapid deployment, bovine pericardial aortic prosthesis on a nitinol stent, which has limited data on outcomes and cost from the United States. Methods We performed a retrospective review of Perceval S implantation at a single center between 2015 and 2018. After exclusion criteria, we compared 262 patients who underwent sutureless aortic valve (SLV) implantation with 394 patients who underwent standard sutured aortic valves (SAVR). Hospital cost data was reviewed, and risk adjustment, done by propensity score and inverse probability weighting, was used to compare outcomes. Results The SLV group was older, had more females, and had a higher proportion of multicomponent operations. For isolated AVR, partial upper hemisternotomy was more frequent in SLV. The median cardiopulmonary bypass and cross clamp times for isolated SLV were significantly lower than SAVR. SLV had a risk-adjusted 11.3% permanent pacemaker (PPM) rate vs 6.1% in SAVR (p=0.016). There were no differences in other postoperative complications (postoperative atrial fibrillation, stroke, renal failure, prolonged ventilation; P>.05 for all). Mortality at any time did not differ between groups. Median hospital costs were higher in the SLV group, likely due to permanent pacemaker rate leading to longer length of stay. Conclusion Sutureless tissue aortic valves can be used safely with lower cardiopulmonary bypass and clamp times than sutured prostheses and facilitate use of minimally invasive approaches with cost neutrality. This valve may be advantageous in older, higher risk patients requiring complex operations.