[HSF] Aortic Valve Conduit with Tissue Valve

[Jbflegejr at aol.com]

I have used porcine aortic heterografts sutured into Hemashield grafts and 
see no reason why pericardial valves would not be just as good. Pick a graft 
that is just a little larger than the sewing ring. The measurement of the sewing 
ring is not necessarily the manufacturer's designation of valve size so the 
diameter should be measured with a caliber, or the circumference with a string. 
The graft should be a couple of millimeters wider than the valve sewing ring. 
Then sew the graft to the sewing ring with a running suture of 4-0 Prolene or 
something similar. The valve implantation sutures are then passed through both 
the sewing ring and attached graft. I have not tried to make neo-sinuses and 
doubt if it matters. Incidentally of four occassions when the bioprosthetic 
valve has worn out, I have replaced it by opening the graft, explanting the old 
valve, and implanting a new one, making sure that the implantation sutures 
passed through the annulus and the end of the graft before the sewing ring, and 
then closing the graft like you would an aortotomy. John Flege