Implantation of a percutaneous valved stent in the orthotopic position with the native valve in place causes coronary ostial obstruction. This problem highlights the need for modified stents that are designed for implantation in patients with non-retracted, fibrotic, or calcified leaflets.

Sutureless implantation of a stented aortic valve through standard CPB and aortotomy is far more complex than expected. Changes in stent design and surgical approach are indicated.