Long-term survival with a stentless free-hand Batista perica
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Stented bovine pericardial prosthetic valves do not require anticoagulation therapy, and are associated with good long-term results in older patients.However, a small aortic annulus is an important contraindication, which can be resolved by insertion of a bileaflet mechanical prosthesis if there are no contraindications to anticoagulation, or by enlarging the aortic root, which increases the operative risk in frail elderly patients because of the need for prolonged cardiopulmonary bypass and ischemic time.The aim of this present report is to describe an alternative operative approach that can be used in an older patient with a small aortic annulus and a contraindication to anticoagulation...

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