Mid-Term Outcomes of the Perceval Sutureless Bioprosthesis for Aortic Infective Endocarditis Victor X Mosquera 1,4 *, Adrian Muinelo-Paul 1 , Bárbara González-Oujo 1 , Oscar Pato-López 3 , Alberto Bouzas-Mosquera 2,4 and José J Cuenca-Castillo 1,4 1 Department of Cardiac Surgery, Spain 2 Department of Cardiology, Spain 3 Department of Anesthesiology, Spain 4 Instituto de Investigación Biomédica de A Coruña (INIBIC) Introduction Aortic rapid deployment and sutureless bioprostheses have opened up a new avenue for treatment of complicated scenarios of aortic Infective Endocarditis (IE). These prostheses allow to technically simplify the intervention, as the aortic annulus manipulation is minimized, and to reduce both Cardiopulmonary Bypass (CPB) and Aortic Cross-Clamp (AXC) times. Nowadays, there is growing evidence to suggest that Sutureless Aortic Valve Replacement (SU-AVR) with the Perceval (Livanova) valve associates with shorter CPB and AXC times as well as with improved hemodynamics compared to conventional stented bioprostheses [1,2]. These features might be especially appealing when operating on patients undergoing complex procedures, as multivalvular surgery [3] or surgery for Infective Endocarditis (IE) [3]. Patients with IE present with increased inflammatory and vasoactive mediators and, usually, with multiple comorbidities [4]. In fact, prolonged AXC and CPB times have been Crimson Publishers Wings to the Research Research Article *Corresponding author: Victor X Mosquera, Department of Cardiac Surgery, Instituto de Investigación Biomédica de A Coruña (INIBIC) Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain Submission: January 11, 2023 Published: February 09, 2023 Volume 5 - Issue 2 How to cite this article: Victor X Mosquera, Adrian Muinelo-Paul, Bárbara González-Oujo, Oscar Pato- López, Alberto Bouzas-Mosquera, José J Cuenca-Castillo. Mid-Term Outcomes of the Perceval Sutureless Bioprosthesis for Aortic Infective Endocarditis. Surg Med Open Acc J. 5(2). SMOAJ.000606. 2023. DOI: 10.31031/SMOAJ.2023.05.000606 Copyright@ Victor X Mosquera, This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited. ISSN: 2578-0379 1 Surgical Medicine Open Access Journal Abstract Background: The implantation technique of sutureless aortic bioprostheses shortens aortic cross- clamp and cardiopulmonary by-pass times, minimizes aortic annulus manipulation, and provides good hemodynamics. These features might benefit the most patients with infective endocarditis. Objectives: This study aims to analyze the mid-term clinical and hemodynamic outcomes of treating complicated aortic infective endocarditis with Perceval (Livanova) bioprostheses. Methods: Since January 2009, over 1300 consecutive patients underwent an aortic valve replacement with a Perceval bioprosthesis. Among them, between July 2014 and June 2022, 36 patients were operated on because of an aortic infective endocarditis. Results: Median euroSCORE I was 34% (rank, 10.5%-85%) and median euroSCORE II was 15.8% (rank, 5.5%-79.2%). Preoperative echocardiographic evaluation revealed perivalvular extension in almost 60% of the cases. All surgeries were performed on an urgent basis. The most frequently implanted prosthetic size was L (41.7%), followed by size XL (27.8%), size M (25%) and size S (5.5%). An associated procedure was necessary in 50% of the patients. Mean CPB and AXC times were 72.6±36.4 and 48.8±26.5 minutes, respectively. Thirty-day mortality was 13.9%. Cumulative follow-up was 852.1 patient-months. Long-term survival at 1 year and 5 years was 72.1% and 61.4%, respectively. There were no cases of endocarditis relapse or new IE during the follow-up. Conclusions: The Perceval sutureless aortic bioprosthesis provides an excellent alternative for surgical treatment of challenging and time consuming complicated both native and prosthetic aortic IE. This sutureless valve seems to allow a rapid, reproducible, and technically feasible repair, shortening both aortic cross-clamp and cardiopulmonary by-pass times. Keywords: Infective endocarditis; Sutureless valve; Aortic valve replacement; Perceval Abbreviations: AXC: Aortic Cross-Clamp; CPB: Cardiopulmonary Bypass; ICU: Intensive Care Unit; IE: Infective Endocarditis; NVE: Native Valve Endocarditis; PVE: Prosthetic Valve Endocarditis; SU-AVR: Sutureless Aortic Valve Replacement; TEE: Transesophageal Echocardiogram