We describe our surgical technique to manage a small aortic annulus during aortic valve replacement. Starting with the posterior annular enlargement incision described by Manouguian, a stentless porcine aortic root, with excision of the left and right porcine coronary segments and conservation of the mural wall (Freestyle MS design, Medtronic, Minneapolis, MN), was used. The Freestyle bioprosthesis enlarges the aortic annulus using a direct suture of the valve on the enlarged annulus, and the aorta is closed by a direct suture of the mural wall of the bioprosthesis. Therefore, the aortic annulus enlargement is made only using the aortic bioprosthesis, without other material. © 2012 The Society of Thoracic Surgeons.
Bical, O. M., Nutu, O., & Deleuze, P. (2012). A technique of aortic annulus enlargement with a freestyle stentless bioprosthesis. Annals of Thoracic Surgery, 93(2), 680–681. https://doi.org/10.1016/j.athoracsur.2011.08.046