A clinical case of aortic valve replacement with the Medtronic Freestyle stentless bioprosthesis implanted in the ≪full-root≫ technique

Aim: to present the results of surgical treatment of a patient with a narrow fibrous ring of the aortic valve by replacing it with a frameless prosthesis

Material and methods: this article discusses a clinical case of aortic valve replacement with a frameless Freestyle Medtronic prosthesis using the "full root" technique in a patient with a narrow fibrous ring and severe stenosis. According to the results of Echo before surgery, the diameter of the fibrous ring of the aortic valve was 17 mm, the maximum gradient on the valve was 119 mm Hg, average 68 mm Hg, valve opening - 5 mm, effective orifice area - 0.5 cm2. According to coronary angiography, stenosis at the mouth of the left coronary artery (LCA) was 75%.

Results: the patient underwent aortic valve and aortic root replacement with a Medtronic Freestyle 19 mm biological prosthesis using the "full-root" technique, and left coronary artery trunk replacement with a Uni-Graft 6 mm prosthesis using the Svensson technique under artificial circulation and cold cardioplegia with Custodiol solution. In the postoperative period, the maximum gradient was 12 mm Hg, the average was 5 mm Hg. The patient was discharged in a stable condition without clinical signs of heart failure

Conclusion: using a frameless biological prosthesis with the «full-root» implantation technique in a patient with critical aortic valve stenosis and an ascending aorta diameter of 20 mm, we achieved the best hemodynamic result. The additional time required for this technique of implantation of frameless prostheses compared to implantation of pericardial framed valves does not affect early clinical results and may be rewarded with better mid- and long-term results. The presented technique does not have a negative effect on early morbidity or mortality and can be recommended for use in patients with a combination of severe aortic valve stenosis and a narrow aortic root.

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