Technique of aortic valve replacement with the Edwards Stentless Aortic Bioprosthesis 2500

Abstract

Aortic valve replacement with a stentless device ought to result in superior hemodynamic function, because obstructing stents and sewing rims are eliminated. From 15 June 1991 to 15 October 1991, 15 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. Patients' ages ranged from 51 to 70 years (mean 61 years). Preoperatively 4 patients presented with aortic regurgitation, 7 with aortic stenosis and 4 with combined lesions; 7 patients were male and 8 female. No additional cardiac or noncardiac diseases were encountered. The operations were performed under normothermic extracorporeal cardiopulmonary bypass and cold cardioplegic cardiac arrest. The implanted valves ranged from 21 mm to 27 mm in diameter. Ten patients received a subcoronary implantation with the lower row of stitches made up of interrupted sutures and the upper row of a continuous suture. In 5 patients the so-called miniroot technique was used, also with lower interrupted sutures and running upper sutures, after adaptation of coronary ostia to the performed openings in the graft. Aortic cross-clamp time ranged between 73 min and 94 min (mean 82 min). There was no operative mortality or morbidity. Postoperative echocardiography showed no signs of aortic valve regurgation in any patient and continuous wave-Doppler measurements showed that resting pressure gradients across the aortic valve were absent or low. Our preliminary experiences with a stentless aortic xenograft valve show that in presence of an increased cross-clamp time an improved hemodynamic function will be obtained. Further studies will be needed, however, to establish the long-term behavior of this device.

Aortic valve replacement with the Edwards Prima plus stentless bioprothesis

“…In patients with moderate amdoectasia and wide but nonarieurysmal enlargement of the aortic root, the inclusion cylinder technique may be helpful. 6,7 As with other replacement devices, concomitant surgery increases the risk of surgery, a However, mortality with and without concomitant surgery is in the range reported in other series and for other replacement devices. One nmst take into account that our patients constitute a nonselected cohort, because our general policy is to offer stentless valves to males over age 40 to 45 and females over age 60 to 65.…”

Seven-Year Performance of the Edwards Prima Plus Stentless Valve with the Intact Non-Coronary Sinus Technique

“…The technique of implant was freehand, subcoronary grafting using 4–0 interrupted braided sutures for the inflow and 4–0 running monofilament sutures for the outflow. After completion of the inflow sutureline, and prior to positioning the prosthesis in the left ventricular outflow, the two coronary sinuses were excised in a scalloped fashion, while the non‐coronary sinus was left intact 9 . The subcoronary outflow suture was begun below the right coronary ostium, and then run toward the right‐to‐non‐coronary and intercoronary commissures, respectively.…”

“…After completion of the inflow sutureline, and prior to positioning the prosthesis in the left ventricular outflow, the two coronary sinuses were excised in a scalloped fashion, while the non-coronary sinus was left intact. 9 The subcoronary outflow suture was begun below the right coronary ostium, and then run toward the right-tonon-coronary and intercoronary commissures, respectively. A second outflow suture was begun below the left coronary ostium and run toward the intercoronary commissure, which was tied with the other end outside the aortic wall, and subsequently toward the leftto-non-coronary commissure.…”

“…However, partial or complete root replacement represents more complex, thus potentially more morbid, surgical procedures particularly in patients presenting for isolated AVR. The intact non‐coronary sinus technique, on the contrary, is a simple modification of freehand subcoronary grafting originally proposed by Ross for aortic homografts, 8 which can be easily applied to stentless valve models manufactured as full porcine aortic roots (Medtronic Freestyle, Edwards Prima Plus) 9 . Due to ability to stabilize two of three commissures, this technique may theoretically secure sinotubular junction dimensions, and prevent late graft dysfunction.…”

“…The intact noncoronary sinus technique, on the contrary, is a simple modification of freehand subcoronary grafting originally proposed by Ross for aortic homografts, 8 which can be easily applied to stentless valve models manufactured as full porcine aortic roots (Medtronic Freestyle, Edwards Prima Plus). 9 Due to ability to stabilize two of three commissures, this technique may theoretically secure sinotubular junction dimensions, and prevent late graft dysfunction. The aim of this study was to define the late clinical and functional outcome after AVR, using the Edwards Prima Plus stentless xenograft implanted with intact non-coronary sinus technique.…”