Sutureless and transcatheter aortic valve replacement: When rivals become allies

In recent years, sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve replacement (TAVR) have emerged as viable alternatives to standard surgical aortic valve replacement (AVR) in higher risk patients. We report seven cases in which SU-AVR and TAVR were used as bailout procedures for each other. Between June 2011and August 2018, 626 patients underwent SU-AVR with the Perceval S prosthesis, and 588 patients underwent TAVR at the Montreal Heart Institute. Herein, we report the cases of seven patients who underwent both procedures within a short time frame: three patients who underwent SU-AVR with a Perceval prosthesis after a failed TAVR procedure, three patients who underwent TAVR after degeneration of a surgically implanted Perceval sutureless prosthesis, and one patient who was scheduled for multiple percutaneous interventions — including TAVR, right coronary angioplasty, atrial fibrillation ablation with left atrial appendage occlusion—who suffered a peri-procedural complication requiring an emergent surgery, during which a Perceval sutureless prosthesis was deployed. All patients were discharged home alive. Two patients suffered a complete heart block requiring permanent pacemaker implantation. We demonstrate that SU-AVR with the Perceval S prosthesis and TAVR are complementary procedures within the therapeutic armamentarium to treat aortic valve disease in higher risk patients. Specifically, valve-in-valve TAVR is an attractive option in the setting of Perceval prosthesis degeneration, whereas SU-AVR is a useful bailout option in the context of peri-procedural failure of a TAVR.