Long-term follow-up after sutureless Perceval S valve implantation as bail-out strategy in a hostile environment

Homograft implantation accounts for less than 1% of aortic valve replacements [1]. This technique is used for a variety of complex aortic valve and root diseases because of its various advantages, including an excellent haemodynamic profile, good perioperative haemostasis, a low risk for thromboembolism and a decreased risk for prosthesis infection [1]. Thus, homografts are preferentially implanted in cases of advanced endocarditis. On the other hand, reoperations of a homograft are considered to be challenging owing to potentially severe adhesions and calcifications. Hence, clamping and suturing may increase the risk of neurological complications [1]. The Perceval S prosthesis (fig. 1) is, as a result of its sutureless and rapid deployment design, a potential substitute for sewing the valve in a calcified setting. Its elastic nitinol stent securely anchors the valve without the need for any sutures [2, 3].