The Sorin stentless pericardial valve: implant technique and hemodynamic profile

Stentless porcine xenografts have had significant impact on the hemodynamics, left ventricular remodeling, and survival after aortic valve replacement. We sought to establish a similar trend for the stentless pericardial valve. In a consecutive unselected series of 54 patients over 65 years of age, we refined the implant method for the stentless aortic pericardial valve and defined the pitfalls. We used a detailed echocardiographic study designed by the Food and Drug Administration to define the early valve hemodynamics and changes in left ventricular function. The valve is user friendly. With an easily reproducible implant technique, very low mean (7.1+/-3.4 mm Hg) and peak (13.6+/-6.3 mm Hg) transvalvular gradients were obtained, which did not decline significantly with time. Left ventricular mass index declined accordingly over 6 months (147+/-49 g/m2 to 125+/-39 g/m2). Mild aortic regurgitation, which did not influence left ventricular mass regression, occurred (26%) predominantly in the first half of the series because of size discrepancy between the annulus and a dilated sinotubular junction. Aortic regurgitation was virtually eliminated by tailoring of the sinotubular junction in the noncoronary sinus. The stentless pericardial valve provides excellent early hemodynamics and is a realistic alternative to the stentless porcine xenograft or aortic homograft for subcoronary aortic valve replacement in elderly patients. Valve durability is yet to be defined.