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.