Primary Implantation Failure
Primary implantation failed in 14 patients (14%) but finally 100 patients (97%) benefited of a Percaval-S implantation. This very high rate of primary implantation failure (compared to current literature18–20) is explained because we considered any situations where a second valve deployment was required even if the same Perceval-S was reemployed. Fail situations are described in Figure 3.
In three patients (21%), the valve exhibited an obvious instability after its deployment and was redeployed in good position before closing the aorta, with an additional SCAP in one patient. In the 11 other patients (79%), a paravalvular leak was identified after weaning CPB, requiring a second clamping to attempt to settle this issue. In seven patients (50%), the same Perceval-S was redeployed in good position, with an additional SCAP in three patients. In one case (7%), the valve size needed to be increased from M to L. In the three remaining cases (21%), the Perceval-S valve was replaced by a sutured bioprosthesis (Trifecta St Jude Medical, MI, USA); in two of these, a total aortic root replacement had to be performed using a Freestyle aortic root bioprosthesis (Medtronic, Dublin, Ireland). Overall, SCAP enabled the implantation of Perceval-S in four patients (29%) in whom the first implantation had failed.