Aortic valve replacement and the stentless Freedom SOLO valve

Aortic valve stenosis has become the most prevalent valvular heart disease in Europe and North America, and is generally caused by age-related calcification of the aortic valve. For most patients, severe symptomatic aortic stenosis needs effective mechanical relief in the form of valve replacement before it becomes a lethal obstruction to outflow. This dissertation focuses on the evaluation and performance of the stentless Freedom SOLO bioprosthesis. We found several clinical and hemodynamic advantages for the Freedom SOLO. Due to the implantation technique, there are few patients that require the implantation of a permanent pacemaker. In addition, the postoperative valvular gradients are excellent and remain stable during midterm follow-up, with large effective orifice areas. Furthermore, structural valve deterioration and aortic valve reoperation are infrequent. However, because of its specific design and implantation technique, not every patient profits from this valve and therefore patient selection is crucial. Based on our extensive implant experience we presented our contraindications for the use of the Freedom SOLO. We discussed several options in the event of a degenerated Freedom SOLO and reported for each technique the pitfalls. Additionally, 4D flow MRI, a new imaging modality, was used to compare stentless and stented valves in a pilot study.
At this moment, the Freedom SOLO should be considered for use in patients with a small aortic root, or in patients that in any other way are at risk for prosthesis-patient mismatch, or in patients that could profit from the superior hemodynamic performance and the large effective orifice area.