A supra-annular malposition of the Perceval S sutureless aortic valve: the 'χ-movement' removal technique and subsequent reimplantation

The Perceval S sutureless valve prosthesis has recently been introduced as a new biological aortic valve prosthesis, but a specific learning curve is required, as for every cardiac surgical centre dealing with a new technique. After the removal of the stenotic valve, the prosthetic valve is correctly positioned within the mildly decalcified aortic annulus. When a supra-annular malposition occurs, due to an excessively rapid release of the prosthesis in the aorta or incomplete annular visualization, the Perceval S valve can safely be removed even after balloon dilation. The procedure performed is a 'chi-movement' with the aid of anatomical forceps. If the prosthesis does not show any malformation after the procedure, it can be reimplanted in the correct intra-annular position.