Implantation of the Sorin Perceval® sutureless aortic valve: A step by step approach

Since the introduction of the sutureless Perceval® (Sorin Group, Saluggia, Italy) in Europe after CEmark in 2012, the "sutureless approach" is becoming more and more popular. Sutureless implantation in general is easy, fast and safe, but bears several potential pitfalls. This might result in inferior functional results affecting also clinical outcomes. In our center, more than 300 implant procedures have been performed up to date by mainly two senior surgeons. The technique is in the process of spreading to all surgeons performing aortic valve procedures. Proctored activities are completed at our and other institutions, and wetlab activities are conducted in collaboration with the manufacturer's research and development laboratory. This article was written to give a step-by-step advice for surgeons who want to start a sutureless program or even have made limited experience with this approach wanting to reconfirm their technique. The focus is kept on surgical aspects regarding indication, access, intra-operative exposure and implantation of the prosthesis.