Technical aspects of implanting the St. Jude Toronto stentless porcine valve

Stentless xenograft aortic valves were designed to provide superior hemodynamic characteristics and durability, in comparison with stented tissue valves. The senior author (MJR) has implanted 46 St. Jude Toronto stentless porcine valves--with excellent hemodynamic results and no aortic insufficiency--since this valve was released by the Food and Drug Administration in November 1997. Because the implantation technique is significantly different from that of implanting a stented valve, and because proper implantation is critical for proper valve function and avoidance of aortic insufficiency, we discuss our technique in some detail.