Truly stentless molded autologous pericardial aortic valve prosthesis with single point attached commissures in a sheep model.

Objective: Aortic valve cusp extension and free-hand aortic valve replacement with autologous pericardium has been described. The longterm results were shown to be comparable with commercially available aortic bioprostheses. Nevertheless the relatively demanding surgical technique could not find wide acceptance. We developed a new design of a molded aortic valve, fashioned from autologous pericardium, treated briefly with glutaraldehyde, and simplified the implantation technique using single point attached commissures (SPAC). Methods: Moldedautologousvalveprostheseswereimplantedinthesubcoronaryaorticpositionin10sheepwiththecommissuresconnectedtotheaortic wall at three single commissural points (SPAC). The prosthesis mean size was 21.6 1.3 mm and the construction time (excluding 10 min glutaraldehyde treatment) was 6.2 1.2 min. Cardiopulmonary bypass and cross-clamp time was 111.1 12.4 min and 75.0 16.3 min, respectively.Sixsheepwereeuthanizedafter201.2 10.3days(6months)and foursheepwereeuthanizedafter330.8 6.5days(11months) postoperatively.Results:Inallsheep,thevalvewasimmediatelycompetent.Atsacrifice,SPAChasproventobewellanchoredtotheaorticwall and the pericardial valve to be pliable in all cases. The maximum transvalvular gradient after cardiopulmonary bypass and at sacrifice was 3.7 2.2 mmHg and 10.6 5.2 mmHg, respectively. Conclusions: This new truly stentless molded autologous aortic valve with simplified implantation technique (SPAC) makes a reliable implantation in a standard timeframe possible. The simplicity of construction, low cost and absent need for anticoagulation of this molded autologous aortic bioprosthesis offers an attractive alternative and not only for patients in the developing world. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.