The authors do not have any conflict of interest to declare.
We carefully read the recent paper by Singh al. (1) on long-term
follow-up of sutureless Perceval aortic valve in the case of calcified
homograft.
Similar to the authors of the article we report the case of a
77-year-old man who underwent at the age of 56 aortic root replacement
for aortic valve endocarditis with the implantation of cryopreserved 27
mm homograft. At age 69 years he presented a recurrence of endocarditis
causing severe valve regurgitation. During the operation on the
operative field, we report an infection limited to the leaflets while
the rest of the homograft was spared from the infection. For this reason
and considering all the risks related to the removal of the homograft
and aortic root re-replacement, we preferred to remove the homograft
valve leaflets leaving the incorporated homograft in place, and
implanting a Perceval bioprosthesis (Livanova Group S.p.A., Saluggia,
Italy) XL size.
The postoperative course was uneventful. The patient was periodically
evaluated with regular echocardiographic controls. At the moment, the
patient lives with his wife. He is in good clinical condition, with NYHA
functional class I, and no other symptoms are reported. The last TTE
(performed in August 2021) shows a mean transprosthesis gradient of 12
mmHg without paravalvular leaks and normal ejection fraction (57%), no
infective or embolic episodes were reported during the 7 years and three
months follow-up time.
Our experience is a great support to the case previously presented by
Singh al. (1) regarding the use and durability of the Perceval stentless
prostheses. Infective aortic endocarditis represents a great challenge
in cardiac surgery. The consequent clinical setting is associated with
high in‐hospital morbidity and mortality, ranging from 15% to 30% in
the case of native valve endocarditis (2).
Moreover, in the case of prosthetic valve endocarditis (PVE), the
mortality is even higher, between 4% and 30% if surgically treated,
and from 24% to 46% if not surgically treated (3). The surgical
procedures needed are often technically complex, scarcely reproducible,
and highly dependent on surgeons’ skills.
Moreover, sutureless bioprostheses could represent an acceptable
alternative to other substitutes as reproducible solutions in very
complex settings as aortic valve endocarditis or severely calcified
homograft.
Up to now, despite it being clearly demonstrated that sutureless
bioprostheses provide excellent hemodynamic results, little is known
about the long-term outcomes and freedom from reintervention.
In this context, the exceptionality of this case report is that, to the
best of our knowledge, this is the first report of mid-term durability
of Sutureless aortic bioprosthesis used to treat infective aortic valve
endocarditis in high-risk patients.
REFERENCES
- Singh N, Chaudhuri K, Nand P. Long-term durability of a Perceval
aortic valve implanted inside a calcified homograft root in a patient
with Klippel-Trenaunay-Weber syndrome. J Card Surg. 2022
Jan;37(1):242-244. doi: 10.1111/jocs.16091. Epub 2021 Oct 18. PMID:
34662465.
- Habib G,
Lancellotti
P,
Antunes
MJ, et al.
2015 ESC
Guidelines for the management of infective endocarditis: The Task
Force for the Management of Infective Endocarditis of the European
Society of Cardiology (ESC). Eur. Heart J. 2015;36:3075-3128
- Perrotta S, Jeppsson A, Fröjd V et al. Surgical Treatment of Aortic
Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience.Ann. Thorac. Surg. 2016;101:1426–1432