Infective Endocarditis in Perceval Sutureless Valves: Incidence, Diagnostic Challenges, and Management: An Expert Opinion Review

Sutureless aortic bioprostheses have become an established alternative for surgical aortic valve replacement, particularly in elderly and high-risk patients. The Perceval (Livanova) valve, the most widely studied sutureless device, offers favorable hemodynamic performance and reduced operative times but introduces specific challenges when prosthetic valve endocarditis (PVE) occurs. Although the incidence of Perceval PVE is low and comparable to that of conventional bioprostheses, this complication is associated with substantial morbidity and mortality. Diagnosis is often complex due to acoustic shadowing on echocardiography, making multimodality imaging with transesophageal echocardiography, cardiac computed tomography, and [18F]-FDG PET/CT essential. Microbiological profiles resemble those of other biological prostheses, but perivalvular extension and early mechanical instability are frequent. Management follows general PVE principles but often requires early surgical intervention because of the valve's reliance on radial fixation. This review summarizes current evidence on epidemiology, microbiology, diagnostic strategies, treatment, and prognosis of endocarditis involving the Perceval valve, and identifies areas for future research.