The Degenerated Sutureless Valve in Full Root Prosthesis

BACKGROUND: The availability of sutureless prostheses has provided another tool for the treatment of degenerated aortic bioprostheses, mostly those used for aortic root replacement, such as stentless porcine or homograft. However, also sutureless-in-root prosthesis can undergo degeneration, presenting a further surgical challenge. CASE SUMMARY: We present 2 patients facing a degenerated M size Perceval prosthesis, previously implanted in a degenerated Freestyle valve. Both patients received a ballon-expandable valve. One, the younger patient, underwent open-heart surgery for sutureless explantation and then implantation of a new device. The other underwent transcatheter valve-in-valve procedure. DISCUSSION: The treatment of a degenerated sutureless-in-root necessitates re-intervention, with the balloon-expandable devices emerging as a highly promising option also in open-heart setting. TAKE-HOME MESSAGES: Degeneration of Perceval-in-Freestyle bioprostheses can be effectively managed. The choice between surgical and transcatheter implantation should be individualized, considering patient characteristics and anatomical suitability.