HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen Westaby Takahiro Katsumata Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Westaby, S. Articles by Braidley, P. Search for Related Content PubMed PubMed Citation Articles by Westaby, S. Articles by Braidley, P.

J Thorac Cardiovasc Surg 1998;116:477-481
© 1998 Mosby, Inc.

Surgery for Adult Cardiovascular Disease

Valve replacement with a stentless bioprosthesis: Versatility of theporcine aortic root

From the Department of Cardiac Surgery, Oxford Heart Centre, The JohnRadcliffe Hospital, Oxford, United Kingdom.

Received for publication Jan 22, 1998. Revisions requested April 8, 1998; revisions received April 24, 1998. Accepted for publication June 2, 1998. Address for reprints: Stephen Westaby, BSc, FRCS, MS, Oxford HeartCentre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UnitedKingdom.

Objective: Stentless valves conveyimportant hemodynamic benefits but are used selectively depending on aortic rootstructure. The Freestyle valve (Medtronic, Inc, Minneapolis, Minn) is aversatile device that can be implanted by different methods depending onoperating conditions. We aimed to demonstrate that a stentless valve could beused in every patient without increased risk of morbidity or mortality. Wedocumented the effects of this valve on clinical outcome and left ventricularmechanics.
Methods: The Freestyle valvewas implanted by the modified subcoronary method into 200 consecutive unselectedpatients who received a tissue valve in the aortic position and by rootreplacement in 2. Forty-three percent were older than 75 years. Forty percentunderwent coronary bypass. Detailed clinical and echocardiographic follow-up(Food and Drug Administration protocol) was used out to 3 years.
Results: Mean ischemic time was 43 ± 6 minutes forisolated aortic valve replacement and 63 ± 14 minutes with concomitantprocedures. Thirty-day mortality was 6%, none of the deaths being valverelated. Hemodynamic function improved progressively with falling valvegradients and increased effective orifice areas. Left ventricular mass fellwithin normal limits over 2 years, but at 3 years there was a non-valve-relatedupswing. No instances of valve thrombosis, hemolysis, or paravalvular leak werenoted. Less than 5% had mild to moderate aortic regurgitation.
Conclusions: The Freestyle valve can be used in virtuallyevery patient with aortic valve disease and provides superlative hemodynamicoutcome. Hospital mortality and morbidity are similar to those reported forstented valves in an elderly population. (J Thorac Cardiovasc Surg1998;116:477-84)

This article has been cited by other articles:

				O. E. Dapunt, J. Easo, P. P.F. Holzl, P. Murin, M. Sudkamp, M. Horst, and E. Natour Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 554 - 559. [Abstract] [Full Text] [PDF]

				R. F. Padera Jr. and F. J. Schoen Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178. [Full Text]

				N. Shiono, Y. Watanabe, M. Kawasaki, H. Yokomuro, T. Fujii, and N. Koyama Evaluation of Bioprosthetic Valve for Small Aortic Root in Elderly Patients Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 102 - 105. [Abstract] [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]

				X. M. Mueller and L. K. von Segesser A new equine pericardial stentless valve J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1405 - 1411. [Abstract] [Full Text] [PDF]

				F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]

				D. B. Doty and J. R. Doty Stentless Aortic Valve Replacement: Bioprostheses Card. Surg. Adult, January 1, 2003; 2(2003): 889 - 898. [Full Text]

				A. A Arifi, S. Wan, S. Nashef, C. S. Ng, I. Y. Wan, and A. P. Yim Freestyle Xenograft Implantation Technique for Reducing Aortic Insufficiency Asian Cardiovasc Thorac Ann, December 1, 2002; 10(4): 369 - 371. [Abstract] [Full Text] [PDF]

				X. Y. Jin and J. R. Pepper Do stentless valves make a difference? Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 95 - 100. [Abstract] [Full Text] [PDF]

				A C. Yankah Forty Years of Homograft Surgery Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 97 - 100. [Full Text] [PDF]

				A.C. Yankah, H. Klose, R. Petzina, M. Musci, H. Siniawski, and R. Hetzer Surgical management of acute aortic root endocarditis with viable homograft: 13-year experience Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 260 - 267. [Abstract] [Full Text] [PDF]

				X. Y. Jin and S. Westaby Pericardial and porcine stentless aortic valves: are they hemodynamically different? Ann. Thorac. Surg., May 1, 2001; 71 (2007): S311 - S314. [Abstract] [Full Text] [PDF]

				M. Kirsch, E. Vermes, R. Houel, and D. Loisance The freestyle stentless aortic bioprosthesis: more about the subcoronary technique Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 369 - 371. [Abstract] [Full Text] [PDF]

				A. A. Arifi, S. Wan, and A. P. C. Yim Aortic valve incompetence after implantation of Freestyle stentless bioprosthesis: A technical issue? J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 599 - 600. [Full Text] [PDF]

				S. Westaby, M. Horton, X. Y. Jin, T. Katsumata, O. Ahmed, S. Saito, H.-H. Li, and G. L. Grunkemeier Survival advantage of stentless aortic bioprostheses Ann. Thorac. Surg., September 1, 2000; 70(3): 785 - 791. [Abstract] [Full Text] [PDF]

				S. P. Wong, M. E. Legget, S. C. Greaves, B. G. Barratt-Boyes, F. P. Milsom, and P. J. Raudkivi Early experience with the Mosaic bioprosthesis: a new generation porcine valve Ann. Thorac. Surg., June 1, 2000; 69(6): 1846 - 1850. [Abstract] [Full Text] [PDF]

				K. L. Yun, C. F. Sintek, A. D. Fletcher, T. A. Pfeffer, G. S. Kochamba, M. R. Hyde, J. O. Torpoco, and S. Khonsari Aortic Valve Replacement With the Freestyle Stentless Bioprosthesis : Five-Year Experience Circulation, November 9, 1999; 100(90002): II-17 - 23. [Abstract] [Full Text] [PDF]

				K. Niwaya, R. C. Elkins, C. J. Knott-Craig, K. Santangelo, M. B. Cannon, and M. M. Lane Normalization of left ventricular dimensions after ross operation with aortic annular reduction Ann. Thorac. Surg., September 1, 1999; 68(3): 812 - 818. [Abstract] [Full Text] [PDF]

				N. D. Kon, A. R. Cordell, S. M. Adair, J. E. Dobbins, and D. W. Kitzman Aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis Ann. Thorac. Surg., June 1, 1999; 67(6): 1609 - 1615. [Abstract] [Full Text] [PDF]

				N. Mediratta, A. W. Sosnowski, and M. Galiņanes POSTERIOR AORTOVENTRICULAR BLEEDING AFTER SUPRA-ANNULAR STENTLESS AORTIC VALVE REPLACEMENT J. Thorac. Cardiovasc. Surg., May 1, 1999; 117(5): 1031 - 1032. [Full Text] [PDF]

				X. Y. Jin, R. Pillai, and S. Westaby Medium-term determinants of left ventricular mass index after stentless aortic valve replacement Ann. Thorac. Surg., February 1, 1999; 67(2): 411 - 416. [Abstract] [Full Text] [PDF]