Perceval S Implantation Technique
Procedures were mainly performed through median sternotomy or,
alternatively, via an upper J ministernotomy. After starting
cardiopulmonary bypass (CPB), a transverse aortotomy was made around 1.5
cm above the STJ. The aortic valve cups were excised and the annulus
conscientiously decalcified to be sufficiently flexible while avoiding
annulus lesion. The size of the Perceval-S valve was chosen according to
the dedicated sizer and the manufacturer’s
recommendations13. The Perceval-S valve was collapsed
into the delivery system and positioned using three guiding sutures
placed 1mm below the nadir of the aortic valve cusps. These guiding
sutures were retrieved after valve expansion. The correct position of
the valve inflow ring on the aortic annulus was visually checked.
Dilatation with the dedicated balloon was then performed for 30 seconds
(either at 2 or 4 atm) at 37°C. The aortotomy was closed using a double
Blalock running suture, and after deairing the heart, the aortic clamp
was removed and the CPB weaned. Intraoperative transesophagal
echocardiography (TEE) confirmed the good position and functioning of
the valve, as well as the absence of paravalvular leak prior to CPB
removal.