OBJECTIVES: Aortic valve replacement (AVR) the most common heart valve operation, accounts for a majority of all valve surgery performed in the elderly. Mini-invasive aortic valve replacement (MiAVR) has several advantages over full sternotomy, mainly less surgical trauma, decreased blood loss, lower mortality and faster recovery. However, it’s also associated with some draw-backs, as an increased technical complexity and higher aortic cross-clamp circulation times (CCTs). 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,  an independent risk factor for worse outcomes, allowing to expand the pool of operable patients with MiAVR. Aim of this simulation study was to predict costs and outcomes of isolated 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 and on the surgical technique (mini-invasive vs. full sternotomy), 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 slightly less than 6,000 € (Italy) to 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 costs for the surgical procedure, shorter hospital stay and complications mangament wtih Perceval S offset its increased cost in all analysed countries.