Implantation of aortic stentless bioprosthesis: case series

To present our preliminary results with stentless aortic valve bioprostheses.

From November 2001 to February 2002, 15 patients (8 men and 7 women) underwent aortic valve replacement with aortic stentless bioprosthesis. The patients age ranged from 50 to 79 years (mean+/-SD, 63.3+/-5.7 years). Three patients had aortic stenosis, 3 aortic regurgitation, and 9 combined aortic pathology. Mean+/-SD left ventricle ejection fraction was 53.0+/-13.9%. Median EuroSCORE was 4 (range, 3-10). Mean+/-SD sinotubular junction diameter measured by transesophageal echo (TEE) was 22.9+/-1.97 mm preoperatively, and the diameter of implanted prostheses was 25.9+/-2.4 mm. All valves were implanted using subcoronary technique. In 5 patients, concomitant myocardial revascularization was performed.

Mean+/-SD total bypass time was 126.7+/-45.9 min (range, 96-180) and cross-clamp time was 88.7+/-15.6 min (range, 69-118). There were no in-hospital deaths or neurological complications. All patients were discharged with only antiagregation agents in therapy. TEE control was performed 1 week after the surgery. The mean systolic gradient across the prosthesis was 25.6+/-5.6 mm Hg and maximum 25.9+/-7.3 mm Hg. No aortic insufficiency was observed in 6 and only minor in 9 patients in postoperative TEE.

Although the implantation of aortic stentless bioprosthesis is technically challenging and time-consuming, early postoperative hemodynamic results are satisfactory.