COMPARISON OF IMPLANTATION TECHNIQUES USING FREESTYLE STENTLESS PORCINE AORTIC-VALVE

Stentless porcine aortic valves demonstrate superior hemodynamic perfo rmance when compared with their stented counterparts. The technical co nsiderations for implanting these valves can be demanding. The Medtron ic Freestyle aortic root bioprosthesis resembles an allograft, has zer o-pressure-fixed leaflets treated with an antimineralization agent, an d can be implanted using a variety of techniques. In this study of tha t valve, total root replacement (TRR) was compared with a partial scal lop aortic inclusion technique (PSI). Implantations were performed in 75 patients (49 PSI and 26 TRR). There were no significant differences with respect to age, sex, or incidence of concomitant procedures. Mea n aortic crossclamp times were significantly less in the PSI group tha n in the TRR group (51.8 +/- 11.7 minutes versus 125.5 +/- 19.7 minute s; p = 0.0001). At discharge, mean systolic gradients seen on color-no w Doppler echocardiography were less in the TRR group than in the PSI group (6.17 +/- 3.66 versus 10.01 +/- 4.83 mm Hg; p = 0.014). Discharg e echocardiography revealed trivial valve regurgitation in 8.3% of the TRR group and in 41.7% of the PSI group (p = 0.004). No patient exper ienced any significant valvular regurgitation on discharge echocardiog raphy. We conclude that early experience with the Medtronic Freestyle aortic root bioprosthesis shows excellent short-term function regardle ss of implantation technique. Shorter crossclamp times, comparable wit h those of stented valve procedures, occurred with PSI implantation. W e anticipate that effects on long-term durability will be beneficial.