ABSTRACT
The new stentless bioprostheses provide improved haemodynamics, rapid resolution of left ventricular hypertrophy and the promise of improved durability with mitigation from early calcification through biochemical treatments.1-6 Superlative valve function and avoidance of anticoagulation with warfarin are compelling arguments for the use of stentless bioprostheses in elderly patients with aortic stenosis.1-3 The only conceivable argument against these valves is the modest degree of operative difficulty and a risk of aortic regurgitation similar to the aortic homograft. Aortic root replacement can be used for patients with severe calcification of the aortic sinuses or an ascending aneurysm. However, the operative mortality for root replacement exceeds that of subcoronary implantation through increased duration of ischaemic time and surgical complexity (Medtronic Freestyle study data). We have now used the Freestyle valve in 200 consecutive patients to receive a tissue valve in the aortic position, irrespective of the morphology of the aortic root or preoperative clinical condition. Having documented excellent valve haemodynamic function with rapid resolution of left ventricular hypertrophy,4,5 we prospectively studied the structure and function of the aortic root and the propensity for postoperative aortic regurgitation over a 3-year follow-up.
