Surgical Technique
Surgical aortic valve replacement was carried out in a typical fashion,
with minor variation among surgeons. Briefly, cardiopulmonary bypass
with right atrial and aortic cannulation, mild hypothermia, and a
combination of retrograde and direct ostial cardioplegia was used.
Transverse aortotomy with sharp excision of the valve, followed by valve
sizing and implantation using interrupted, pledgeted sutures of 2-0
braided, permanent suture was employed. De-airing after closure of
aortotomy was carried out with transesophageal echo (TEE) guidance, and
TEE used to evaluate valve function after weaning from bypass.