IMAGES IN CARDIAC SURGERY
Implantation of a sutureless bioprosthesis without guiding
sutures in a heavily calcified aortic root
Anne-Kristin Schaefer MD
Claudia Oeser MD
Alfred Kocher MD
Günther Laufer MD
Martin Andreas MD, PhD
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
Anne-Kristin Schaefer MD, Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Sutureless bioprostheses have been used to facilitate complex
multivalvular procedures, and difficult aortic root surgery.
report images of a patient in which a sutureless bioprosthesis was
inserted into a heavily calcified aortic root without guiding sutures.
A 39-year-old male presented with exertional dyspnea 16 years
following a full root replacement with a cryopreserved aortic
homograft for endocarditis. A transthoracic echocardiogram (TTE)
revealed severe aortic regurgitation with a mean aortic gradient of
23 mmHg. A chest computed tomography (CT) scan showed extensive
circumferential calcification of the homograft and aortic root (Figure 1).
Following a resternotomy, the institution of cardiopulmonary bypass
and cardioplegic arrest, a transverse aortotomy revealed that the left
coronary cusp was detached. The remaining leaflets were excised. The
root was extensively calcified such that it was impossible to place any
sutures through the annulus. A size “S” Perceval aortic sutureless valve
(LivaNova, London, UK) was positioned in the annular plane without
the use of guiding sutures. The unique “valve-on-a stick” design of this
valve, with its small diameter in the collapsed form, allowed for easier
passage through the sinotubular junction, and to assess its position
visually before deployment in the annular plane. The patient tolerated
the procedure well, and a post-bypass transesophageal echocardio-
gram showed normal valve function without any paravalvular leak
(PVL). A post-op CT scan showed that the valve was well positioned in
the annulus (Figure 2). The patient is now 28 months post-op, has no
cardiac symptoms, and a TTE shows a mean aortic gradient of
10 mmHg with no PVL.
FIGURE 1 Preoperative computed tomography scan shows circumferent calcification of the homograft and a narrow sinotubular junction
J Card Surg. 2018;33:103–104. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.