RESUMO
Medtronic Freestyle Stentless bioprosthesis as well as stented bioprosthesis, can lead to structural valve deterioration (SVD) or disruption of the porcine aortic root. Seventeen years ago, a 52-year-old woman with aortitis syndrome underwent aortic root replacement in a full-root fashion for aortic regurgitation (AR) with a Freestyle aortic bioprosthesis. A recent follow-up echocardiogram revealed severe AR due possibly to SVD. Thus, we planned an aortic valve replacement (AVR) for AR with possible leaflet tear of the prosthesis. Upon completion of AVR while the aortotomy was being closed, however, a disruption in the porcine aortic wall was found. Root replacement had to be performed because of this finding. In stentless valve reoperation long after AVR with the full-root method, both the porcine aortic root and leaflets can be disrupted. Aortic root replacement may be necessary if preoperative images reveal dilatation, as well as disruption of the sinus of Valsalva.
RESUMO
We report a case of a 79-year-old woman who underwent apicoaortic conduit bypass (ACB) surgery for severe calcific aortic valve stenosis. We did not perform conventional aortic valve replacement because of the patient's advanced age and because she had a small aortic annulus (17 mm) and a high risk of bleeding and cerebral infarction. ACB surgery through a left thoracotomy was performed via a femorofemoral bypass. A hand-made valve conduit was made from the left ventricular apex to the descending aorta. Her postoperative course was uneventful ; postoperative echocardiography showed a decreased pressure gradient at the native aortic valve between the left ventricle and the aorta. This procedure is useful in high-risk patients with severe calcified aortic valve stenosis.