title: Reoperation for Freestyle stentless aortic valves.
abstract: Ten patients who initially underwent Freestyle stentless aortic valve implantation required reoperation. The goal of this study was to describe the reoperative techniques used and to review the outcomes of reoperation in patients with Freestyle stentless aortic valves. From September 1992 to April 2001, at the University of Michigan, a total of 552 Freestyle stentless aortic valves were implanted, and in 10 (1.8%) of these patients (7 men, 3 women) a reoperation was required. The mean age at the time of the initial implantation was 53.5 +/- 14.1 years. Implantation techniques included both modified inclusion root (7) and inclusion root (3). Reasons for reoperation included endocarditis (7), aortic aneurysm (1), valve dehiscence (1), and subvalvular outflow tract obstruction (1). Eight patients underwent homograft reimplantations and in 2 Freestyle reimplantations. In all cases, the previous aortotomy was re-entered, the pseudoendothelial layer over the distal suture line of the noncoronary sinus was incised and continued into the other 2 sinuses. Utilizing a ganglion knife, the Freestyle valve was freed from the native aortic tissue to the proximal suture line. The Dacron sewing ring was then separated using sharp dissection and the lower suture line excised. No calcification was noted in any case. The mean time interval between the first and second operative procedure was 13.4 +/- 21.5 months. There were no operative deaths and only one late death. Mean long-term follow-up was 43 +/- 29 months. Reoperation on a Freestyle stentless aortic valve, when necessary, can be accomplished without increased operative risk and with excellent survival.
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, University of Michigan Hospitals, Ann Arbor, MI 48109-0348, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Deeb
authors.forename: I A
authors.initials: IA
authors.lastname: Smolens
authors.forename: S F
authors.initials: SF
authors.lastname: Bolling
authors.forename: M J
authors.initials: MJ
authors.lastname: Eppinger
authors.forename: F D
authors.initials: FD
authors.lastname: Pagani
authors.forename: R L
authors.initials: RL
authors.lastname: Prager
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000209:etiology*; D001021:Aortic Valve / Q000601:surgery*; D004696:Endocarditis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies