Rare prosthesis failure after aortic valve replacement with a Freedom Solo

We report an unusual case of a 78-year-old man readmitted to our Cardiac Surgery Division due to a severe regurgitation of the stentless bioprosthesis Freedom Solo implanted, strictly following the manufacturer's recommendations, approximately six months before for aortic stenosis of native valve. Although different possible etiologies may be determined for the subacute aortic regurgitation of a bioprosthesis, a partial adhesion of a leaflet to the aortic wall represents an exceptional event. The device was explanted, a new different bioprosthesis model was implanted and the patient recovered uneventfully. But no evidence of aortic or leaflet vegetations suggesting for abscess was found, neither atheromatous or calcified plaques, nor signs of inflammation of the aortic wall were detected. In the end, it is believed that the cause of the cuspal adhesion to the aortic sinus was primary tissue failure.