Replacement of the Ascending Aorta and Aortic Root Replacement Using a Freestyle Porcine Bioprosthesis (Inclusion Technique)

The preoperative computed tomography angiography scan is shown in the video. The right axillary artery was cannulated with Seldinger technique, and percutaneous right femoral venous cannulation was performed for cardiopulmonary bypass. A median sternotomy was performed and aortic cross-clamp applied. The ascending aorta and the aortic valve were resected. The left and right ostia of the bioprosthesis were trimmed. A stentless aortic bioprosthesis was implanted, using polypropylene 4/0 running suture for the inflow rim. The authors begin the inflow rim suture line at the left coronary sinus, then the right coronary sinus, and finish at the noncoronary sinus. The coronary ostia are reattached using a polypropylene 4/0 suture, beginning with the left ostia.

A test was performed with a hook to check if aortic paravalvular leaks were present. The proximal anastomosis of the vascular prosthesis including both the patient ascending aorta and porcine aortic wall was performed using polypropylene 4/0 running suture, the “inclusion technique.” A second continuous suture reinforcement was performed using polypropylene 4/0 suture. The distal anastomosis was performed between the aorta and vascular prosthesis using polypropylene 4/0 running suture. The heart and vascular prosthesis were deaired and the cross-clamp removed.

The final result and postoperative echocardiography are shown in the video.