Echocardiographic imaging of stentless aortic valve prostheses

Homografts and stentless xenografts are increasingly used in aortic valve s urgery. Echocardiography technicians and cardiologists have to know, what t hey will find when performing an echo-Doppler examination in patients who r eceived a stentless value. We therefore evaluated echocardiographic images of 74 patients who received a Freestyle stentless bioprosthesis with three techniques and a follow-up of 2 years in, two high-volume hospitals. Of the patients studied, 81% were operated using the subcoronary technique, 12% u sing the root-inclusion technique, and 7% using the full-root technique. Re sults: Transvalvular gradients across the stentless valves were low: 8.0 mm Hg when implanted with the subcoronary technique, 8.2 +/- 5.1 mmHg using th e root-inclusion technique, and 6.5 mmHg using the full-root technique. Tri vial aortic insufficiency (grade 1) was observed in 10.7% of the patients ( 8.9% for the subcoronary technique, 13% for the root-inclusion technique, a nd 0% for the full-root technique). When the bioprosthesis was implanted us ing the subcoronary technique or the root-inclusion technique, the prosthes is was placed inside the recipient aortic root. Using these techniques, a l umen between the double layer of the zenograft and the aortic wall could be observed. With the root-replacement technique, the porcine root became the most proximal part of the ascending aorta. As the native aortic wall was r emoved, in most cases, no double lumen could be observed with imaging of th e ascending aorta.