Superimposition of a mechanical valve on an impacted aortic bioprosthesis.

During reoperation for replacement of a regurgitant aortic bioprosthesis (a 23-mm bovine pericardial valve), it was judged that total removal of the valve would be difficult, and hazardous to the patient. Therefore, its leaflets were excised and its sewing ring left in situ. A 21-mm Carbomedics bileaflet mechanical valve was sutured to the bioprosthetic sewing ring and implanted in the orifice of the bioprosthesis, resulting in excellent hemodynamic performance. We report this new technique to illustrate its feasibility, safety, and efficiency, as an alternative to complete removal of defective prostheses in the aortic position.