# Sutureless Aortic Valve Replacement with Annular Plication Technique in an Oversized Annulus

## TL;DR

A new surgical technique allows implanting a sutureless heart valve in patients with a larger-than-usual aortic annulus, enabling minimally invasive treatment.

## Contribution

The annular plication technique expands the use of sutureless valves in oversized aortic annuli.

## Key findings

- Annular plication successfully enabled Perceval valve implantation in a patient with a 30 mm annulus.
- Postoperative imaging showed no paravalvular leak and good valve function at 3-year follow-up.
- The technique may enhance the applicability of sutureless valves in minimally invasive surgery.

## Abstract

We present the case of a 72-year-old man with symptomatic severe aortic regurgitation and moderate aortic stenosis, and an annular diameter of 30 mm, exceeding the recommended range for sutureless Perceval valve implantation. To reduce the annular size to allow implantation of the Perceval XL valve, an annular plication technique was employed, involving three horizontal mattress sutures placed at the interleaflet triangles. A totally endoscopic approach via right mini-thoracotomy was utilized. Postoperative echocardiography confirmed excellent valve positioning and no paravalvular leak. The patient recovered uneventfully and remained asymptomatic with good prosthesis function at the 3-year follow-up. This case demonstrated that annular plication enables the safe use of the Perceval valve in patients with a mildly oversized annulus and may expand its applicability in minimally invasive settings.

The Perceval valve (Corcym, Saluggia, Italy), known for its sutureless design, has been widely used in minimally invasive cardiac surgery due to reduced aortic cross-clamp time.