Impact of intraoperative post-pump aortic regurgitation with stentless aortic bioprostheses

Stentless aortic bioprosthesis performance may be affected by geometric distortion, and intraoperative echocardiography typically is used to assess prosthetic valve function. The impact of minimal or mild post-pump aortic regurgitation has not been previously investigated. Intraoperative post-pump transesophageal echocardiograms and follow-up transthoracic echocardiograms (up to 3 years' postoperatively) were reviewed for 96 patients who underwent implantation of Freestyle (Medtronic) stentless aortic bioprostheses. Minimal or mild aortic regurgitation was present post-pump in 50 of 96 (52%) patients. On early follow-up examination (n = 80), no patient had more than mild aortic regurgitation. Aortic regurgitation had completely resolved in 24 of 39 (62%) patients with post-pump aortic regurgitation, including 15 of 19 (79%) patients with minimal paravalvular regurgitation. The incidence of mild aortic regurgitation at 2 and 3 years did not appear different between patients with and those without post-pump aortic regurgitation. Minimal or mild aortic regurgitation is common on intraoperative post-pump transesophageal echocardiography immediately after implantation of stentless aortic bioprostheses. Resolution is common, especially of small paravalvular jets. Minimal or mild post-pump aortic regurgitation infrequently results in even mild aortic regurgitation on early follow-up evaluation and does not appear to predict clinically significant progression of aortic regurgitation on long-term follow-up evaluation.