Aortic Valve Replacement with the Medtronic Freestyle Stentless Bioprosthesis

Abstract

During a five-year period from 1996 to 2000, the Medtronic Freestyle stentless bioprosthesis was implanted in 310 patients of advanced age. Age at operation ranged from 60 to 90 years (mean, 76 +/- 4 years). 191 patients were female and 119 male. All implants were done by the modified subcoronary method using our own modification which enabled an improved adaptation of the porcine aortic root to the human anatomy. Two sinuses were scalloped and the third left intact. Additional coronary bypass grafts were necessary in 129 (39%) patients and mitral valve procedures in 23 (7%). Mean perfusion time was 109 +/- 12 minutes and crossclamp time 87 +/- 8 minutes. 16 (5%) patients died perioperatively. Another 17 (5.7%) patients died during a 1 to 5.6 year follow-up (mean, 2.9 years). There was only one valve related death due to infection of the valve. In spite of the advanced age, 95% of the survivors were free from cardiac symptoms and continued to live an active and fruitful life. The biological nature of the valve and the low gradients are perhaps reasons for the good results. The long-term results are expected to be good.

Subcoronary Implantation of a Stentless Valve in Patients with Aortic Aneurysms

“…3 We have further modified and standardized this procedure. 4 The aneurysmally dilated aortic root is more conical than cylindrical, and our method converts it back to a cylinder to avoid dead space between the aorta and the porcine valve. Arterial cannulation was carried out on the aortic arch in all patients.…”

Replacing the diseased aortic valve and the proximal aorta in the elderly patient

“…Over 21,000 of these valves have been implanted during the last 10 years. The vast majority of these implants have been done using the modified subcoronary method which we have already reported and described in detail [3].…”

“…Over 21,000 of these valves have been implanted during the last 10 years. The vast majority of these implants have been done using the modified subcoronary method which we have already reported and described in detail [3].High arterial cannulation on the aortic arch enables clamping of the aorta just below the origin of the brachiocephalic trunk. Cardioplegia is usually given retrograde through a catheter in the coronary sinus.…”

Freestyle Stentless Bioprosthesis for Active Aortic Infectious Endocarditis with Undetermined Causative Organism

“…Despite small population studies, all patients in the above reports were free from recurrent endocarditis. Recently, John et al 17 reported only 1 valve-related death due to infection of the Freestyle valve among 310 patients of advanced age. The excellent postoperative hemodynamic performance of the Freestyle valve has been demonstrated, 18 -23 and further experimental or clinical prospective evaluations should be required to elucidate whether the Freestyle bioprosthesis can be used as an alternative to homografts in the treatment of severe endocarditis and for the prevention of recurrent endocarditis.…”