The previously placed annular sutures are now being passed through the ring of the prosthesis (porcine). The choices for valve repalcement are: mechanical, bioprosthetic, homograft or autograft. Mechanical (e.g. St. Jude's, et. al.) require long-term anticoagulation (Coumadin) and hence the patient cannot have a contraindication to blood thinners. They have the best longevity (i.e. freedom from failure). Bioprosthetic valves (porcine valve or bovine pericardium) do not require anticoagulation but have a lower longevity, they are used for young women who want o get pregnant, patients who do not want to be on blood thinners or patients who cannot take blood thinners (history of gastrointestinal or cerebral bleeding). The homograft is the aorta with its valve taken from a cadaver, frozen and then rewarmed and used as a replacement. They do not require anticoagulation and seem to have good longevity. The operation to put a homograft in is much more difficult than the routine aortic valve replacement. An autograft refers to the use of the patient's own pulmonary valve as an aortic valve replacement. The pulmonary valve is then replaced with a cadaveric homgraft. This is called the Ross Procedure. It is thought by some that the pulmonary valve in the aortic position will last longer than a cadaver homograft. This is the most difficult operation to do.
Link to this frame from your Personal Thumbnails page?