Challenging surgical management of failed freestyle stentless porcine valve: two case reports

The Freestyle Stentless Porcine Valve (Medtronic, Fridley, MN, USA) has excellent hemodynamics and can be implanted as either an isolated aortic valve replacement (AVR) or full aortic root replacement. It has excellent durability with documented 15-year freedom data from structural valve degeneration. Open surgical replacement of a failed Freestyle valve, however, can be challenging. Despite minimal calcification of the aortic valve cusps and porcine aortic tissue, there are often dense adhesions between the Freestyle prosthesis and native aortic sinus tissue following a complete subcoronary implantation technique. Valve explant can lead to significant damage to native sinus tissue and typically necessitates an aortic root replacement at the second operation. Herein we present two cases of redo-aortic root replacement following previous Freestyle AVR using the complete subcoronary technique. Patient 1 presented with symptomatic Freestyle regurgitation and patient 2 presented with symptomatic Freestyle stenosis eleven-and nine-years post Freestyle implantation respectively. The case reports describe two different operative interventions. The preoperative work up and perioperative management are also included.