Aortic valve replacement with the Unique Suture Line Stentless USL porcine valve: A new, simple, and safe stentless valve implantation technique.

The Stentless USL, Unique Suture Line porcine valve, is a stentless bioprosthesis developed following the advantages of the studies of the physiology of the aortic root as a functional unit. The direct suturing of the porcine tissue on the soft and elastic tissue of the host's aortic annulus and root gives the bioprosthesis the possibility to follow the physiological movements of the natural valve during the cardiac cycle. For the same reason, there is decreased stress on the valve tissue, especially at the commissural level. There is less technical demand for surgeons who have limited experience with the freehand or miniroot technique due to the limited availability of the homografts because the Stentless USL valve can be implanted with the same technique used with a conventional stented valve. The implant technique used for the Stentless USL valve has advantages, especially in the small aortic calcified annulus in elderly patients where the freehand technique can be difficult and the second suture line can be dangerous (i.e., coronary ostium near the aortic ring or in calcified aortic wall). Our experience with this stentless valve in approximately 200 patients (> 70 years old) shows it to have excellent hemodynamic results even in small valve sizes. The use of this valve and the simple implantation technique avoids the need for complicated aortic root enlargement procedures.