Implantation of stentless aortic root prosthesis using an inversion technique

Commentary: One rose does not make a bouquet

“…We agree with Hiremath and Bhatnagar 3 that the ability to perform a proximal anastomosis with clear view of the suture line is extremely important, especially in procedures like redo root and reconstruction of a small root, and in scenarios in which because of a lack of annular tissue, suturing exerts tension on the annulus by working the needle at a nonperpendicular angle, potentially leading to suture-line bleeding or to left ventricular–aortic discontinuity. Since its approval for clinical use in North America, the stentless porcine bioprosthetic root has been proved to be extremely versatile.…”

“…In this issue of the Journal , Hiremath and Bhatnagar 3 describe treating extensive infective endocarditis in a young patient. The authors used a technique of aortic root implantation in which a porcine bioprosthetic root was inverted within the LVOT to facilitate the anastomosis.…”

Commentary: Inversion technique for stentless aortic root—is it wise and necessary?

“…In the current edition of JCTVS Techniques , Hiremath and Batnaghar 1 present a technique of stentless aortic root tissue valve implantation using the inversion technique in a single case. The group favors the inversion technique for the implantation of the Medtronic Freestyle prosthesis to enhance visualization and accurate suture placement in a case of infective endocarditis.…”

“…When necessary, the annulus can be stabilized by other means, eg, with pericardial patches or strips in case of major annular tissue loss. 1 Implanting a stentless aortic root prosthesis at a lower level in the left ventricular outflow tract has not been proven to be advantageous but may cause more conductance disturbances and pacemaker requirement. 2 , 3 , 4 Finally, the decision to implant a Freestyle in a 19-year-old patient may be considered as questionable, since this tissue valve will most probably not last for a long time in this age group.…”

“…When necessary, the annulus can be stabilized by other means, eg, with pericardial patches or strips in case of major annular tissue loss. 1 …”