• Theodor Fischlein, Bart Meuris, Thierry Folliguet, Kavous Hakim-Meibodi, Martin Misfeld, Thierry Carrel, Marian Zembala, Elisa Cerutti, Federico M Asch, Axel Haverich, and CAVALIER Trial Investigators.
• Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. Electronic address: Theodor.Fischlein@klinikum-nuernberg.de.
• J. Thorac. Cardiovasc. Surg. 2022 Dec 1; 164 (6): 17721780.e111772-1780.e11.

ObjectiveThe objective of this study was to report midterm clinical outcomes with a self-expandable sutureless aortic valve.MethodsBetween 2010 and 2013, 658 patients at 25 European institutions received the Perceval sutureless valve (LivaNova Plc, London, United Kingdom). Mean follow-up was 3.8 years; late cumulative follow-up was 2325.2 patient-years.ResultsThe mean age of the population was 78.3 ± 5.6 years and 40.0% (n = 263) were 80 years of age or older; mean Society of Thoracic Surgeons-Predicted Risk of Mortality score was 7.2 ± 7.4. Concomitant procedures were performed in 31.5% (n = 207) of patients. Overall duration of cardiopulmonary bypass time was 64.8 ± 25.2 minutes and aortic cross-clamping time was 40.7 ± 18.1 minutes. Thirty-day all-cause mortality was 3.7% (23 patients), with an observed:expected ratio of 0.51. Overall survival was 91.6% at 1 year, 88.5% at 2 years, and 72.7% at 5 years. Peak and mean gradients remained stable during follow-up, and were 17.8 ± 11.3 mm Hg and 9.0 ± 6.3 mm Hg, respectively, at 5 years. Preoperatively, 33.4% of those who received the Perceval valve (n = 210) were in New York Heart Association functional class I or II versus 93.1% (n = 242) at 5 years.ConclusionsThis series, representing, to our knowledge, the longest follow-up with sutureless technology in a prospective, multicenter study, shows that aortic replacement using sutureless valves is associated with low mortality and morbidity and good hemodynamic performance.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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