OBJECTIVES: Aortic valve replacement (AVR) is the most common heart valve operation, accounting for a conspicuous part of all valve surgery performed in the elderly.  A significant subset of patients with indications for valve surgery are deemed ineligible for conventional valve replacement because of high-risk features or age. Prolonged aortic cross-clamping times (CCT) are an independent risk factor for worse outcomes. Perceval S is a new aortic valve which is implanted without need for suturing and a collapsed profile, thus allowing a significant reduction of cross-clamping times. Aim of this simulation study was to predict costs and outcomes of concomitant AVR procedures associated with this new valve in 4 European countries (Italy, France, Germany, and UK), as compared to traditional valve implants, from the cost perspective of the hospital. METHODS: A probabilistic, patient-level simulation model was fully coded in WinBugs, permitting a seamless integration of parameter estimation and outcomes prediction, which was entirely based on the associated CCTs, through published correlations. Unit cost were retrieved from official and literature sources for all countries. Besides the incorporated probabilistic sensitivity analysis, a series of deterministic sensitivity analyses was performed. RESULTS: The model predicts less complications with the use of the Perceval S valve, and savings (valve cost excluded) ranging from about 6,000 € (Italy) to about 6,700 £ (UK), mainly related to a reduction in surgery costs and ICU/hospital bed days. Extensive sensitivity analyses confirm the robustness of such findings. CONCLUSIONS: Reduced cross clamping times associated with the implantation of Perceval S result in relevant savings on surgical, complication managment and hospital stay costs in all analysed settings.