Figure 1

Operative steps for the implantation of the Medtronic Freestyle. (A) Resection of the Sinus of Valsalva and application of crystalloid cardioplegia over the coronary ostia. (B) Exposure of the heavily calcified aortic valve and isolation of the coronary buttons. (C) Placement of pledgetted braided sutures along the aortic annulus for aortic root implantation. (D) Passing of braided sutures through the buttressed rim of the stentless valve for aortic root implantation. (E) Reimplantation of the coronary ostia into the porcine aortic root using polypropylene sutures after knot-down of the annulus sutures to re-establish myocardial perfusion. (F) Replacement of the ascending aorta with a vascular prosthesis in this case of aneurysmatic dilation and placement of epicardial pacemaker wires.