主动脉瓣人工瓣膜置换术156例分析

目的总结成人主动脉瓣人工机械瓣膜置换手术的经验.方法1996年1月至2005年1月对156例成人行主动脉瓣置换,术中均行人工机械瓣膜置换,其中双叶瓣125例,单叶瓣31例.13例行瓣膜侧倾缝合,6例行主动脉瓣瓣环加宽.结果存活151例,死亡7例,死亡率4.48%.结论对主动脉瓣膜行人工机械瓣瓣膜置换手术术前充分估计瓣环大小,术中良好的灌注、心肌保护、选择合适瓣膜和恰当手术方法,可降低死亡率.     

儿童主动脉瓣置换术15例临床分析

目的总结儿童主动脉瓣置换术的治疗经验。方法对15例14岁以下儿童主动脉瓣膜置换术患者的临床资料进行回顾性分析。结果本组患儿年龄(12.7±1.8)岁,均在全麻中低温体外循环下手术。主动脉瓣置换采用带小垫片涤纶线间断褥式缝合,所用人工瓣膜均为双叶机械瓣,瓣膜直径≥19 mm。术后服用华法林抗凝,INR维持在1.5～2.0。无手术及住院死亡病例,术后早期并发一过性三度房室传导阻滞1例、频发室性早搏2例、切口愈合不良1例。术后心脏彩超复查,左心室流出道及左心室腔轻度动力性梗阻1例,轻微瓣周瘘1例。术后随访3个月～7 a,所有患者心功能指标较术前有显著改善,机械瓣膜功能良好,无因生长发育出现机械瓣膜相对狭窄,无抗凝相关并发症发生。结论病情允许时尽量推迟到年龄较大时行儿童主动脉瓣膜置换手术,采用新型双叶机械瓣效果良好,术后华法林低强度抗凝安全可靠。     

人工心脏瓣膜的进展

作者在五十年代早期对钙化的主动脉瓣施行扩张术,其疗效不佳。1958年直视下去除主动脉瓣叶的钙化斑,能降低压力阶差,但1～2年内仍恢复原样。随后用 Bahnson 聚四氟乙烯人工瓣膜置换主动脉瓣,术后1～2年内产生钙化和瓣叶破裂,对少数存活者再用 Starr-Edwards球瓣置换。在主动脉根部狭小的病人,Starr-Edwards 球瓣能产生9.3kPa 跨瓣压,8例中有6例死亡。此后采用自体心包人工主动脉瓣,但六个月内瓣膜磨损和破裂。用自体阔筋膜人工瓣膜,但仍在4～5年内皱缩和钙化。用 Kay-Shiley 扁平碟瓣作主动脉瓣置     

小主动脉根部行主动脉瓣置换术两种不同术式的对比

目的回顾性对比小主动脉根部条件下,使用St.Jude Regent瓣行主动脉瓣置换术和主动脉根部扩大重建后行主动脉瓣置换术的围术期风险及术后早期疗效。方法将41例小主动脉根部条件下施行主动脉瓣置换术患者,分为两组,一组为St.Jude Regent瓣组,另一组为主动脉根部扩大重建组,收集患者围术期相关资料以及术后早期超声心动图下血流动力学指标。使用SPSS软件进行统计学分析。结果围术期两组患者比较主动脉阻断时间、术后当天出血量方面存在统计学意义。主动脉根部扩大组1例术后出现低心排血量综合征,终因呼吸功能衰竭死亡,1例安装永久起搏器,1例胸骨哆开;St.Jude Regent瓣膜组中1例出现术后低心排血量综合征,经积极治疗顺利出院。术后近期复查,两组均无死亡病例,未发现严重并发症。对比术前两组患者心功能均有明显改善,左室舒张末直径、主动脉瓣压差、有效瓣口面积指数间差异有统计学意义。而两组患者术后对比,相关数据不存在统计学意义。结论对于小主动脉根部患者直接使用19mm St.Jude Regent瓣膜进行主动脉瓣置换术,相比主动脉根部扩大重建术而言,手术时间短,简单易行,围术期风险较小,术后血流动力学指标无明显差别。     

小主动脉瓣环患者应用ATS.AP瓣置换20例效果分析

目的观察小主动脉瓣环患者置入ATS.AP瓣是否存在置入瓣膜与患者不匹配(Prosthesis-PatientMismatch,PPM)现象。方法选择2008-01～2010-03间20例主动脉瓣环径≤20 mm行ATS.AP瓣置换患者(小瓣环组)及20例非小主动脉瓣环行常规机械瓣置换患者(正常瓣环组),用彩色多普勒超声仪对患者左心功能进行术前、术后监测,比较其术前、术后左心功能指标的变化,比较术前术后主动脉瓣跨瓣峰值压差、主动脉EOA指数,观察有无发生机械瓣与体表面积不相匹配现象(PPM)。结果小瓣环组术后左室重量指数、主动脉跨瓣峰值压差、左室后壁厚度较术前显著降低(P0.01);左心室射血分数、主动脉瓣EOA指数显著增高(P0.01)。两组术后比较仅主动脉跨瓣峰值差异有统计学意义(P0.01),其余各项指标比较差异均无统计学意义(P0.05)。结论小主动脉瓣环患者置换ATS.AP瓣后无置入瓣膜与患者不匹配现象,左心功能指标接近或达到正常瓣环瓣膜置换者。     

60～70岁患者主动脉机械瓣与生物瓣中期疗效对比

目的 对比分析60~70岁患者行主动脉瓣机械瓣置换与生物瓣置换术后生存率、术后瓣膜并发症情况及再次手术率的差异。 方法 回顾性分析2005年1月至2015年12月在解放军总医院第一医学中心心血管外科行主动脉瓣机械瓣置换的64例60~70岁患者与同年龄段的147例行主动脉瓣生物瓣置换的患者的病例资料。根据术前基线资料,利用倾向性评分匹配方法对患者分组。分组后比较两组患者瓣膜置换术后的生存率、瓣膜相关病死率、瓣膜相关并发症发生率及再次手术率的差异。 结果 倾向性评分匹配后,机械瓣组与生物瓣组术后6年,两组患者的生存率及瓣膜相关病死率无统计学差异(P=0.160,P=1.000)。机械瓣组术后并发症包括机械瓣非结构性功能异常1例(2.1%),栓塞1例(2.1%)、出血1例(2.1%),生物瓣组术后并发症包括瓣膜血栓1例(2.1%)、栓塞4例(8.2%)。总体的并发症发生率两组无统计学差异(P=0.321)。生物瓣组6年内再次手术1例(2.1%),机械瓣组未发生再次手术,组间比较无统计学差异(P=1.000)。 结论 我中心60至70岁年龄段患者行主动脉瓣机械瓣或生物瓣置换术后6年的生存率、瓣膜相关病死率、并发症发生率及再次手术率无明显差异。     

经胸超声心动图评价无支架生物主动脉瓣功能特点

目的应用经胸超声心动图(TTE)评估无支架生物主动脉瓣功能特点,指导临床术后心功能恢复用药,观察其远期效果.方法随机对无支架生物主动脉及有支架生物主动脉瓣置换术后病人各8例进行超声心动图检查.结果无支架组和有支架组病人术前TTE各项指标测值差异无统计学意义,术后的各项指标测值差异有统计学意义.结论TTE显示无支架生物主动脉瓣较有支架生物主动脉瓣更具符合人体半月瓣及血流动力学.     

小主动脉瓣环患者应用小口径生物瓣的临床疗效观察

目的 回顾性分析行小口径（≤21 mm）生物瓣置换和机械瓣置换的小主动脉瓣环患者的临床资料,比较生物瓣置换术后患者血流动力学与机械瓣置换的差异,探讨在小主动脉瓣环的患者中应用小口径生物瓣行主动脉瓣置换术的可行性及安全性。方法 收集2020年11月至2022年8月在武汉亚洲心脏病医院接受治疗的147例小主动脉瓣环患者临床资料和治疗情况,其中机械瓣膜组74例,生物瓣膜组73例。所有患者均符合主动脉瓣置换术手术指征,均行小口径的瓣膜置换。收集患者基线资料、既往病史、术前及术后超声心动图结果、手术相关数据等指标。结果 两组患者体外循环时间、主动脉阻断时间比较无明显统计学差异（P>0.05）。21 mm生物瓣与20 mm机械瓣比较,术后左心房内径[（36.4±7.0）mm比（37.2±10.2）mm,P>0.05],左心室舒张末期内径[（45.7±5.0）mm比（44.4±7.0）mm,P>0.05]未见统计学差异,生物瓣术后射血分数优于机械瓣[（61.1±7.0）%比（57.4±10.4）%,P=0.034],生物瓣术后主动脉跨瓣压峰值差劣于机械瓣[（25.8±7.5）mmH...     

儿童主动脉瓣置换术临床特点及中远期随访结果

目的 总结15岁以下儿童主动脉瓣置换术的临床特点及中远期随访结果,探讨手术指征、瓣膜选择等相关问题.方法 回顾性分析2006年1月至2014年1月上海交通大学医学院附属新华医院15岁以下29例行瓣膜置换患者临床资料.其中男性19例,女性10例,年龄2～15（10.66±3.55）岁.病因：先天性主动脉瓣发育异常24例,感染性心内膜炎5例.手术均在中度低温体外循环下进行,其中主动脉瓣置换22例、主动脉瓣二尖瓣双瓣置换术7例,均采用机械瓣膜.所有瓣膜置换均采用间断褥式缝合方法,术中采用Manouguian法行主动脉根部加宽5例;术后使用主动脉内球囊反搏（IABP）辅助2例.术后以华法林抗凝治疗,维持INR在2.0～3.0.结果 患者CPB时间（126.39±68.44）min,主动脉阻断时间（77.39±48.23）min.全组院内死亡1例.术后出现并发症3例,其中心律失常1例（窦性心动过缓、阵发性房室传导阻滞）,呼吸衰竭l例,急性肾衰竭1例,均经治疗后痊愈.随访1个月至8年,平均3.5年,随访期无死亡,所有患者机械瓣功能均良好,无再次手术,无抗凝相关并发症.结论 对于儿童主动脉瓣疾病患者,选择合适的手术时机进行主动脉瓣置换术,围术期及术后密切治疗,近期及中远期疗效均良好.     

多普勒超声心动图对同种主动脉瓣功能的评价

本文报道了应用多普勒超声心动图技术评价１１例同种主动脉瓣移植术后的近期疗效及同种瓣的血液动力学特征。研究发现，同种主动脉瓣的最大血流速度及最大跨瓣压差显著低于主动脉瓣位机械瓣，与正常自体主动脉瓣比较无显著差别。术后左室舒张末期内径明显缩小，左室射血分数显著增加。     

Short-term hemodynamic performance of the Sorin Freedom SOLO stentless valve

BACKGROUND AND AIM OF THE STUDY: The new Sorin Freedom SOLO pericardial stentless valve is designed for supra-annular implantation, and requires only one running suture. It can be implanted with a short cross-clamp time, and is designed to offer the same hemodynamic advantages of other stentless valves. The study aim was to evaluate the prospective postoperative and two-month follow up hemodynamic performance of this bioprosthesis. METHODS: Thirty patients (13 males, 17 females; mean age 75.6 +/- 6.21 years) with severe aortic stenosis underwent valve replacement with the Sorin Freedom SOLO stentless valve. All patients underwent transthoracic echocardiography before surgery, before hospital discharge, and at two months' follow up. The peak and mean transprosthetic gradients, telediastolic and telesystolic diameters, septal and posterior wall thicknesses, total and indexed ventricular mass volume and left ventricular ejection fraction were evaluated. RESULTS: Both, the transprosthetic peak gradient and mean gradient decreased significantly during the first two months (p < 0.05 and p < 0.001, respectively). The telediastolic diameter was significantly reduced between preoperative evaluation and follow up (p < 0.05). The interventricular septum thickness was decreased significantly after two months (p <0.001), as was the posterior wall thickness, albeit to a lesser degree (p < 0.05). Both, total and indexed ventricular mass volume showed a significant regression at the two months follow up (p < 0.001). CONCLUSION: The Sorin Freedom SOLO stentless valve shows good hemodynamic performance, with an early and highly progressive left ventricular remod eling. If these data are confirmed in future studies, the SOLO prosthesis might represent a safe alternative to the use of conventional stentless valves.     

Aortic valve replacement with new-generation stentless pericardial valves: short-term clinical and hemodynamic results

BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) with stentless bioprostheses offers superior hemodynamics. In order to overcome the disadvantages of older, stentless valves, a new generation of pericardial stentless prostheses has been developed. Herein, the hemodynamic and clinical results of these substitutes have been evaluated. METHODS: Between March 2002 and May 2004, 85 patients (59 females, 26 males; mean age 73.6 +/- 6.1 years) who underwent AVR received either a bovine (Sorin Pericarbon Freedom; SPF; n = 50) or an equine (3F Aortic Bioprosthesis; 3F; n = 35) pericardial stentless valve. Patients were followed up prospectively at six months after surgery by clinical and echocardiographic examination. The mean follow up period was 5.6 +/- 0.8 months, and was 96.4% complete. RESULTS: Mortality was 2.4% at 30 days (two SPF patients; one died at reoperation for suspected valve thrombosis and one was a non-valve-related death) and 2.5% at follow up (two SPF patients; both nonvalve-related). Neither structural valve failure nor endocarditis were observed. Preoperatively, there were no differences in baseline data, functional status and hemodynamics between SPF and 3F patients. The aortic cross-clamp time was similar in both groups (51.7 +/- 11.2 min for SPF; 51.6 +/- 8.2 min for 3F). NYHA functional status improvement was similar in each group (1.8 +/- 0.5 for SPF; 1.7 +/- 0.6 for 3F). The mean transaortic pressure gradient (deltapmean) was reduced in all patients during follow up. With SPF, a lower deltapmean was found for smaller aortic roots (indexed annular diameter (IAD) < 14 mm/m2) as well as in larger (IAD > 14 mm/m2) aortic roots: 8.0 +/- 4.5 mmHg versus 13.2 +/- 7.2 mmHg (p < 0.05) and 6.8 +/- 3.0 mmHg versus 12.8 +/- 4.8 mmHg (p < 0.05), respectively. CONCLUSION: New-generation pericardial stentless aortic valves are very pliable, which facilitates their implantation. Clinical and hemodynamic results with these prostheses are promising. The SPF prosthesis demonstrates excellent performance, and may be superior when implanted in small aortic roots.     

Three years' experience with the sorin pericarbon stentless prosthesis: mid-term results with three different implantation techniques

BACKGROUND AND AIM OF THE STUDY: Sorin Pericarbon stentless pericardial valves were implanted using three different surgical techniques, and early and mid-term clinical and hemodynamic results were analyzed according to the method used. METHODS: Between January 2000 and December 2002, 102 Pericarbon stentless valves were implanted in 101 patients (55 females, 46 males; mean age 67.6+/-7.1 years). Among these patients, 63 had isolated aortic valve replacement and 39 underwent a combined procedure. The inflow portion of a matching-size prosthesis was fixed to the aortic annulus either by semi-continuous Prolene suture (n = 48), interrupted simple Ethibond (n = 29) or interrupted Ethibond mattress stitches (n = 25). Valve sizes were not significantly different in the three subgroups. The aortic cross-clamp and cardiopulmonary bypass times were 145+/-31 min and 171+/-39 min, respectively, with interrupted stitches; these times were significantly longer than in the continuous suture group (115+/-27 min and 143+/-45 min) or with interrupted mattress stitches (111+/-28 min and 137+/-34 min). RESULTS: Early mortality was 6.8% (n = 7) for the entire patient group. None of the deaths was valve-related. Postoperatively, all patients were followed up (mean 26.6+/-9.4 months). There were two late deaths (both non-valve-related). One patient developed early endocarditis, and the infected valve was re-replaced with another Pericarbon stentless valve. During the follow up period the mean and peak transvalvular gradient was decreased from 12.8+/-8.5 mmHg to 9.1+/-2.3 mmHg and from 22.5+/-13.9 mmHg to 16.1+/-4.3 mmHg respectively, and left ventricular wall thickness from 15.5+/-2.1 mm to 12.8+/-1.4 mm. Regurgitation was not more than trivial for any of the implanted valves. The implantation technique did not significantly affect the hemodynamic performance of the Pericarbon stentless valve. CONCLUSION: The Sorin Pericarbon stentless pericardial prosthesis showed excellent hemodynamic performance, even if implanted in a matching-size aortic root. The implantation technique used had no significant influence on valve performance.     

Stentless valves for aortic valve replacement: where do we stand?

PURPOSE OF REVIEW: Following more than a decade's experience with stentless valves and the development of better profiled stented valves, the article discusses the advantages of stentless valves regarding hemodynamic performance, left ventricular mass regression, durability and survival. RECENT FINDINGS: Recent studies show that stentless valves remain hemodynamically superior compared with modern porcine stented valves. This superiority is, however, rarely reported in comparison with modern pericardial stented valves. In general, patient-prosthesis mismatch is less frequent in stentless vs. stented valves. Recent randomized trials comparing stentless valves and modern stented valves show equivalent left ventricular mass regression at 1 year. At 10 years, stentless valve durability is excellent and comparable with that of stented valves. Recent comparative studies do not confirm the previously reported midterm survival advantages of stentless valves. SUMMARY: Improvement of stented valves has significantly reduced the hemodynamic differences between them and their stentless counterpart. Patients with small aortic annulus, however, should benefit from a stentless valve due to the better expected gradients and lower risk of patient-prosthesis mismatch. Midterm results suggest equivalent durability and survival for both prosthesis types but additional and longer-term trials are necessary to confirm these results.     

Exercise Echocardiography in Cryopreserved Aortic Homografts: Comparison of a Prototype Stentless,a Stented Bioprosthesis,and Native Aortic Valves

Background: Aortic valve replacement with a cryopreserved aortic homograft (CH) is an attractive alternative to bioprosthesis implantation. The aim of the study was to compare the hemodynamic performance of CH implanted with aortic root inclusion compared to prototype stentless (SS) bioprosthesis, standard stented (SD) bioprosthesis, and a native aortic valve. Methods: Hemodynamics and Doppler echocardiographic measurements such as left ventricular ejection fraction, aortic valve orifice area index (AVOAI), mean and maximal transvalvular gradients, were obtained at rest and immediately after exercise in 28 patients after aortic valve replacement with CH (n = 10), SS (n = 9), or SD (n = 9), and in a control group (CG) of 15 normal volunteers. Results: Rest and peak exercise heart rate and workload achieved were not different among the groups. Baseline AVOAI was larger for CH and CG compared to SS and SD groups (P < 0.05). Maximal and mean transvalvular pressure gradients at rest were lower for CH compared to SS and SD groups (P < 0.05), but higher than CG (P < 0,05). Conclusion: Implanted aortic CH had better hemodynamic performance than SS and SD bioprosthesis and similar to native normal aortic valves, both at rest and immediately after exercise. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Hemodynamic changes after valve replacement with starr-edwards prostheses

A brief review of the pathophysiology of aortic and mitral valve disease and the hemodynamic results of valve replacement with caged ball prostheses are described. In most patients intracardiac pressures are restored to normal at rest, although there are small pressure gradients across mechanical valves. Severe pulmonary hypertension, if present, usually will regress. With exercise, abnormalities of left atrial pressure or left ventricular function may be found after valve replacement. The causes of failure to achieve hemodynamic improvement with surgery and the late return of congestive failure are discussed.     

Long-term results with the Biocor-SJM stentless porcine aortic bioprosthesis

BACKGROUND AND AIM OF THE STUDY: The study aim was to update the clinical analysis of hemodynamic performance, structural failure and survival in patients undergoing aortic valve replacement (AVR) with a composite aortic, aldehyde tanned, stentless porcine bioprosthesis. METHODS: Between January 1990 and March 2001, 247 patients underwent AVR with aortic stentless valves. Patient demographic and clinical analysis included age, sex, valve lesion, valve size, pre- and postoperative NYHA class, hospital morbidity, mortality, operative data and duration of hospitalization. RESULTS: Mean patient age was 47.3 years; 71% of patients were males, and 45% had aortic insufficiency. The incidence of rheumatic heart disease requiring surgery was 41.7%. In 23% of patients surgery was indicated due to aortic stented bioprosthetic dysfunction. Preoperatively, 81% of patients were in NYHA classes III and IV. Mean follow up was 5.9+/-2.8 years (range: 1 month to 11.4 years); total follow up was 1,392 patient-years (98% complete). The valve size used was < or =25 mm in 75.3% of patients. The mean intensive care unit stay was 2.6 days; mean hospital stay was 10.7 days. Hospital mortality was 4.0% and late death 6.1%. There were no valve-related deaths. Postoperatively, the mean aortic effective orifice area (EOA) was 1.71 cm2, the mean peak transvalvular gradient 17.1 mmHg, and the mean transvalvular gradient 9.0 mmHg; the left ventricular mass index (g/m2) was 174 and 117 before and after surgery respectively. The rate of leaflet tissue degeneration was 0.9%, and seen as mild by echocardiographic follow up. Actuarial survival at almost 12 years was 91%, and freedom from reoperations was approximately 99%. CONCLUSION: Patients with aortic stentless valves have hemodynamic benefits seen as larger aortic EOA, low transvalvular gradients, satisfactory left ventricular remodeling with significant reduction of left ventricular mass, low complication rate, low reoperation rate, lower leaflet tissue degeneration rate, and no valve-related mortality. A longer follow up is required to confirm these benefits.     

Influence of prosthesis size and left ventricular mass on left ventricular diastolic reserve in patients with aortic valve prostheses

BACKGROUND AND AIM OF THE STUDY: The study aim was to determine the influence of valve size and left ventricular (LV) mass on long-term LV diastolic reserve in patients subjected to aortic valve replacement for stenosis. METHODS: Seventy-four patients (33 women, 41 men; mean age 64 years) after aortic valve replacement with 40 pericardial bioprostheses and 34 bileaflet mechanical prostheses were studied. All valves were of nominal size 19, 21 or 23 mm. The patients were studied by Doppler echocardiography, at rest and during peak effort, between 12 and 47 months after valve replacement. RESULTS: All patients achieved significantly increased heart rate, blood pressure and cardiac output in response to effort. Effort also significantly modified transvalvular pressure drops and valve areas. The mean diastolic reserve was 29.3 ml, and mean stroke volume reserve 23.2 ml; in neither case were there any significant differences between valve types, or among valve sizes. CONCLUSION: At about one year after surgery, the diastolic reserve of patients subjected to aortic valve replacement on account of stenosis was considerable, and independent of valve size. Despite the persistence of LV hypertrophy after valve replacement, LV diastolic function during effort was similar to that of the normal heart.     

Haemodynamic performance of aortic pericardial bioprostheses and bileaflet prostheses at rest and during exercise: implications for the surgical management of patients with small aortic roots

OBJECTIVE: To determine the haemodynamic behaviour, at rest and during exercise, of aortic valve pericardial bioprostheses and different sizes of bileaflet prosthesis. DESIGN: Observational study. SETTING: Tertiary medical centre. PATIENTS AND INTERVENTIONS: 74 patients (33 women, 41 men; mean age 64 years) in whom 40 pericardial bioprostheses and 34 bileaflet prostheses sized 19, 21, or 23 mm had been implanted to replace aortic valves. MAIN OUTCOME MEASURES: Doppler echocardiography at rest and at peak exercise, between 12 and 47 months after surgery. RESULTS: All patients achieved a significant increase in heart rate, systolic blood pressure, and cardiac output with exercise. Transvalvar pressure fall, valve area, and left ventricular systolic and diastolic function indices also underwent significant changes with exercise. Reductions in peak and mean transvalvar pressure, at rest and at peak exercise, were greater in patients with small valves (p < 0.05). Valve areas and effective area index were greater in the patients with larger valves (p < 0.001). There were no significant differences between patients with mechanical and biological prostheses with regard to transvalvar pressure fall and valve areas at rest and at peak exercise. CONCLUSIONS: 19 mm and 21 mm aortic prostheses and bioprostheses continue to create significant obstruction, particularly with exercise.     

ECHOCARDIOGRAPHIC HEMODYNAMIC ASSESSMENT OF STENTLESS AND SUPERSTENTLESS AORTIC BIOPROSTHESES IN TERMS OF SURVIVAL ADVANTAGE

Porcine xenografts as stentless and recently superstentless bioprosthetic aortic valves are anticipated to cause improved hemodynamics and increase longevity over stented bioprostheses. Stentless valves showed extremely good flow characteristics. Durability has been reported to be better than in stented xenografts accompanied by low gradients, rare and only trivial aortic valve regurgitation. As during the last years the well‐known and attractive aortic bioprostheses stentless St. Jude Toronto SPV and superstentless Shelhigh were often used all over the world including in our institute, we will present their morphologic and functional assessment. Toronto SPV prosthesis requires two suture lines to be implanted. The first row of sutures is between the left ventricular outflow tract and inflow of the valve and the second between the aortic sinuses and the valve. The subcoronary technique of the implantation is intraannular with aortic root as a stent. The diameter of sinotubular junction during diastole is crucial for valve competence and when it exceeds the diameter of the aortic annulus by more than 3 mm, the root is dilated and this valve should not be used. At the completion of the implantation of the valve, the sinotubular junction should not exceed the diameter of the valve. On the contrary, Shelhigh superstentless bioprosthetic aortic valves require one suture line and no sutures are needed in the vicinitiy of the coronary arteries (which might also distort the base of the valve). A composite valve mounted on a superflexible ring has three separate cusps, which allow the best hemodynamic characteristics. Valve implantation is easy with mini or total root replacement and with the possibillity of oversizing the valve conduit by one to three sizes enhancing the hemodynamic advantages. A complete echocardiographic examination included the estimation of maximal and mean transvalvular gradients from transthoracic 5‐chamber view or transesophageal transgaastric view, as well as calculations of effective orifice area by the continuity equation or with planimetry in transesophageal short axis view, especially in the cases of aortic regurgitation. Effective orifice area index, a predictable measure of patient–prosthesis mismatch was calculated at the time of operation or postopertively. Aortic prosthesis valve regurgitation was recorded by pulsed and color Doppler. Left ventricular size, systolic and diastolic function are important clues regarding the severity of regurgitation. Transesophageal assessment of the structure and function of the bioprosthetic stentless valves in short and longitudinal axis provides the evaluation of clinical performance. Measurement of left ventricular mass after aortic valve replacement with both bioprosthetic stentless valves has been done by the truncated ellipse method. Twenty‐eight patients undergoing aortic valve replacement were assigned to receive either Toronto stentless or Shelhigh superstentles aortic valve. Transthoracic and transesophageal echocardiograms were performed after 1 week, 3 months and 6 months, postoperatively. We found maximal systolic transvalvular gradients ranged from 18 to 26 mmHg and mean systolic transvalvular gradients from 8.5 to 12 mmHg with effective orifice area from 1.5 to 2.1cm² without significantly changes in both groups. Thesegradients after 3 and 6 months postoperatively dropped more in the Toronto stentless group, but not significantly hemodinamicly in relation to Shelhigh superstentles group, and the effective orifice area ranged in both groups from 2.4 to 2.8 cm². Left ventricular mass had fallen in both groups but the degree of mass reduction was comparable. Diastolic function has significantly improved in both groups. In conclusion,we had only trivial regurgitation in two cases of Toronto stentless group. Stentless bioprostheses convey hemodynamically and possibly survival benefit through a low incidence of valve‐related complications. Owing to more recent developments of stentless technology with the most advanced anticalcification treatment and superior hemodynamic performance due to maintenance of the normal aortic physiology and flexibility of the aortic root, it is felt that these valves could last 15 years or longer.They will probably provide a useful alternative to aortic homografts in the future.