Stentless Aortic Bioprosthesis for Disease of the Aortic Valve, Root and Ascending Aorta

Abstract

Disease of the aortic valve is frequently associated with morphologic abnormalities of the ascending aorta and the aortic arch. Ectasia of the ascending aorta is commonly associated with bicuspid aortic valve. Degenerative aortic valve disease is often associated with atherosclerotic deposits or aneurysm in the ascending aorta and the aortic arch. Aortic valve disease causing hemodynamic burden sufficient to affect left ventricular structure or function is indication for operation to replace the aortic valve. Current practice dictates replacement of the ascending aorta and/or arch in combination with replacement of the aortic valve because the aortic disease usually does not stabilize and, in fact, progresses despite resolution of disease of the aortic valve. Similarly, aortic disease requiring primary operative intervention in the presence of morphologic abnormalities of the aortic valve is best treated by combined replacement operation because of the frequency of early reoperation on the aortic valve. More aggressive treatment of combined aortic valve and aortic disease has been prompted by the frequent necessity of reoperation for progression of associated morphologic abnormalities, availability of improved aortic valve bioprostheses, and improved ability of surgeons to treat associated disease in a single operation. This article demonstrates use of a stentless aortic root bioprosthesis to replace the aortic valve and aortic root for aortic valve disease associated with (1) aneurysm of ascending aorta; (2) extensive atherosclerotic ulcerated plaque disease of aorta; and (3) coarctation of aorta. These operations are applied in adults and in all cases used the Medtronic Freestyle® aortic root bioprosthesis (Medtronic, Inc., Minneapolis, MN). This device was chosen because of proven efficacy and durability, excellent hemodynamic performance, and no requirement for anticoagulant therapy. 1