A new approach for severe aortic regurgitation in porcelain aorta with sutureless Perceval valve: A case report

Abstract

Introduction: The association of pure aortic regurgitation and porcelain aorta represents a challenging situation. In the Transcatheter Aortic Valve Implantation (TAVI) era, porcelain aorta (PA) becomes an additional risk for patient treatment and sometimes serves as the primary indication for the TAVI approach, even in low-risk patients. Devices currently on the market are not yet validated for the treatment of pure aortic regurgitation (AR) in PA and mid/long-term results are still not available. Furthermore, small calcified sinotubular junction and the association of small Valsalva sinus with low origin of coronaries ostia represent a relative contraindication of TAVI.

Presentation of case: We report a case of severe symptomatic AR associated with a PA in a patient successfully treated with a sutureless Perceval valve.

Discussion: The sutureless Perceval valve may represent an excellent option. This valve requires less manipulation of the ascending aorta and no manipulation of the aortic annulus except for the aortic valve leaflets removal. Furthermore, it can be implanted also in a small and calcified sino-tubular junction because the valve is collapsible before the implant.

Conclusion: The present case represents a proof that self-expandable cardiac valve technology can be employed to treat, either by surgery or by catheter, selected cases of AR. We have observed an excellent mid term result with no paravalvular leak at 2 years.

Keywords: Aortic regurgitation; Aortic valve replacement; Porcelain aorta; Sutureless valve; Transcatheter aortic valve implantation.