Revision aortic valve replacement with a Perceval sutureless valve 40 years after Björk–Shiley monostrut valve: a case report

BACKGROUND: The Björk-Shiley monostrut (BS-M) valve, a tilting-disc mechanical prosthesis introduced to improve durability and reduce structural failure, has demonstrated excellent long-term outcomes in the aortic position. Although structural valve deterioration is rare, non-valvular complications such as pannus formation can necessitate reoperation. We report a rare case of revision aortic valve replacement 40 years after BS-M implantation due to subaortic stenosis caused by pannus formation, utilizing a Perceval sutureless valve to minimize operative risk in the context of impaired cardiac function. CASE PRESENTATION: An 80-year-old Japanese man with a BS-M valve implanted in the aortic position 40 years earlier presented with syncope and progressive heart failure. He had a history of bradycardic atrial fibrillation and had been managed medically for heart failure over the preceding seven years. Transthoracic echocardiography revealed severe aortic stenosis, moderate mitral stenosis, and moderate tricuspid regurgitation, with a significantly reduced ejection fraction. Although the BS-M valve itself exhibited no mechanical damage or disc dysfunction intraoperatively, circumferential pannus formation beneath the prosthesis caused significant subvalvular stenosis. The patient underwent aortic valve re-replacement with a Perceval™ sutureless valve, mitral valve replacement, tricuspid annuloplasty, and left atrial appendage closure. The choice of a sutureless valve was made to reduce myocardial ischemia time. Postoperatively, the patient experienced aspiration pneumonia requiring reintubation; however, he recovered and was transferred to rehabilitation on postoperative day 21. Follow-up echocardiography revealed satisfactory valve hemodynamics and improved ventricular function, with no evidence of prosthetic valve dysfunction. At 8-month follow-up, the patient remained well. CONCLUSIONS: This case highlights the exceptional structural durability of the BS-M valve even after four decades. Nonetheless, non-valvular complications such as pannus formation may necessitate reoperation. Long-term surveillance remains essential for early detection of functional decline, even in patients with structurally intact prosthetic valves.