Technique of aortic valve replacement with the Edwards stentless aortic bioprosthesis 2500.

Aortic valve replacement with a stentless device ought to result in superior hemodynamic function, because obstructing stents and sewing rims are eliminated. From 15 June 1991 to 15 October 1991, 15 patients underwent aortic valve replacement with the newly designed Edwards stentless aortic bioprosthesis 2500. Patients' ages ranged from 51 to 70 years (mean 61 years). Preoperatively 4 patients presented with aortic regurgitation, 7 with aortic stenosis and 4 with combined lesions; 7 patients were male and 8 female. No additional cardiac or noncardiac diseases were encountered. The operations were performed under normothermic extracorporeal cardiopulmonary bypass and cold cardioplegic cardiac arrest. The implanted valves ranged from 21 mm to 27 mm in diameter. Ten patients received a subcoronary implantation with the lower row of stitches made up of interrupted sutures and the upper row of a continuous suture. In 5 patients the so-called miniroot technique was used, also with lower interrupted sutures and running upper sutures, after adaptation of coronary ostia to the performed openings in the graft. Aortic cross-clamp time ranged between 73 min and 94 min (mean 82 min). There was no operative mortality or morbidity. Postoperative echocardiography showed no signs of aortic valve regurgation in any patient and continuous wave-Doppler measurements showed that resting pressure gradients across the aortic valve were absent or low. Our preliminary experiences with a stentless aortic xenograft valve show that in presence of an increased cross-clamp time an improved hemodynamic function will be obtained. Further studies will be needed, however, to establish the long-term behavior of this device.