Stentless aortic valve replacement autograft/homograft

Question 1

What are techniques for homograft placement

Answer 1

1. Subcoronary implant technique: two suture lines within the native root.
2. Homograft cylinder-inclusion technique: sinuses are not scalloped out, instead a button hole is made in the right and left sinuses as to allow the homograft wall to be sewn to the native sinus all around the coronary sinus
3. Root replacement

Question 2

What is main difficulty of homograft re-do

Answer 2

Extreme calcification is common

outcomes of TAVR valve-in-valve are promising

Question 3

What are contraindications for Ross

Answer 3

pulmonary valve disease
congenitally abnormal pulmonary valves
Marfan 
Connective tissue disorder
Active rheumatic disease
Comorbid conditions
	poor LV function, multivessel disease
Ascending aortic dilation
Some believe BAV
Some feel primary AI is less favourable the  AS

Question 4

techniques for a Ross

Answer 4

Subcoronary

Root replacment

Question 5

What ways does the Ross procedure fail

Answer 5

Pulmonary autograft regurgitation

Dilation of the aortic annulus (unless fixation with vascular material

Question 6

What are potential advantage of aortic homografts

Answer 6

Excellent hemodynamics
possible enhanced transvalvular gradients
low risk of thromboembolism without the need for anticoagulation
low risk of prosthetic valve infection