Stentless Aortic Valves are Hemodynamically Superior to Stented Valves During Mid-Term Follow-Up: A Large Retrospective Study (original) (raw)
Related papers
Stentless vs. stented aortic valve bioprostheses: a prospective randomized controlled trial
European Heart Journal, 2007
Aims We sought to assess the haemodynamic profile of the Freedom stentless aortic valve compared with a stented bioprosthesis in a randomized controlled trial using echocardiography. Methods and results Sixty patients (mean age 73 years) undergoing bioprosthetic aortic valve replacement (AVR) were randomized to either Sorin Freedom stentless (n ¼ 31) or Sorin More stented (n ¼ 29) valves. The primary endpoints were left ventricular mass index (LVMI) reduction at 6 and 12-months. We also assessed post-operative effective orifice area index (EOAI), aortic gradient and operative time. There were no significant differences in baseline characteristics. The stentless valve was associated with a lower post-operative gradient [PG 17 (12) vs. 31 (13) mmHg, P , 0.0001] and greater EOAI [1.1 (0.3) vs. 0.8 (0.2) cm 2 /m 2 , P , 0.0001]. A highly significant reduction in LVMI occurred by 6 months in both groups, but LVMI was significantly lower in the stentless group [LVMI 119 (39) vs. 135 (30) g/m 2 , P ¼ 0.05]. However, there was continued regression of left ventricular hypertrophy (LVH) in the stented but not in the stentless group, resulting in no significant difference in LVMI at 12 months [119 (36) vs. 126 (31) g/m 2 , P ¼ 0.42]. Conclusion The use of the Sorin Freedom stentless bioprosthesis for AVR results in lower PG and greater EOA when compared with a Sorin More stented valve. This is associated with earlier regression of LVH.
Are Stentless Valves Superior to Modern Stented Valves?: A Prospective Randomized Trial
Circulation, 2006
Background— It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. Methods and Results— Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patien...
The Annals of Thoracic Surgery, 2007
Background. Stentless aortic bioprostheses were shown to be hemodynamically superior to earlier generations of stented bioprostheses. Modern stented valve designs have improved hemodynamics. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. Our aim was to determine any differences in early postoperative clinical and hemodynamic outcomes. Methods. Patients with severe aortic valve stenosis (n ؍ 161) undergoing aortic valve replacement were randomized intraoperatively to receive either the C-E Perimount (Edwards Lifesciences, Irvine, CA) pericardial stented bioprosthesis (n ؍ 81) or the Prima Plus (Edwards Lifesciences) (porcine stentless bioprosthesis (n ؍ 80). Transthoracic echocardiograms were performed at one week and eight weeks postoperatively to assess left ventricular mass (LVM) and transvalvular gradients (TVG). Results. There were no differences between the two groups in baseline characteristics. Cardiopulmonary bypass and ischemic times were longer in the stentless group. Despite similar native aortic annular diameters, the mean size of the prosthesis used in the stentless group was 2.1 mm (SD ؍ 2.8) larger (p < 0.001). Early (30-day) mortality (stentless 3.7% vs stented 2.5%; p ؍ 0.68) and morbidity was similar between groups. Eight weeks postoperatively, LVM (stentless 199 ؎ 70 vs stented 204 ؎ 66 grams; p ؍ 0.32) and TVG decreased in both groups (mean systolic gradient; stentless 10 ؎ 3 vs stented 10 ؎ 4 mm Hg; p ؍ 0.54) but there was no significant difference between groups. Conclusions. Despite longer ischemic times in the stentless group, early postoperative outcomes were similar. Both stented and stentless aortic valve replacement offers excellent hemodynamics and can be achieved with low perioperative mortality.
Hemodynamic Performance of Stentless Versus Stented Valves: A Systematic Review and Meta-Analysis
Journal of Cardiac Surgery, 2008
Background: Several trials have compared stentless with stented valves following aortic valve replacement (AVR). The goal of this review was to systematically locate, critically appraise, and quantitatively combine results to determine if stentless valves improve cardiac hemodynamics. Methods: We performed an unrestricted search of Pubmed Medline, EMBASE, CINAHL, the Cochrane databases, and EBM reviews. Article reference lists and online abstracts from major North American conferences were also searched. We included randomized trials of adults undergoing AVR that compared stentless and stented valves. Blinded reviewers performed assessment of trials for inclusion and trial quality. Two individuals performed data extraction independently. Kappa statistics were used to assess reviewer agreement. A random effects model was employed for statistical analyses. Assessments were made for postoperative, early, and late outcomes. Heterogeneity was explored with sensitivity analyses. Results: Eight studies were identified for inclusion in the primary analysis, with four others included in sensitivity analyses. Baseline comparisons between groups revealed no differences. Our primary analyses revealed no differences between groups for assessments of LV mass or mean transvalvar gradients. Secondary analyses showed stentless valves to have lower peak gradients. Sensitivity analyses were supportive of our primary results. Heterogeneity was observed in some comparisons and sensitivity analyses failed to completely explain this heterogeneity. Conclusions: Stentless valves did not display hemodynamic benefit in terms of LV mass regression or postoperative mean gradients, but do appear to display superior hemodynamics in terms of peak gradients. Further well-designed and adequately powered trials are required to fully address this question. doi: 10.1111/j.1540-8191.2008.00705.x (J Card Surg 200823:556-564) Aortic stenosis (AS) is a common condition affecting up to 7% of adults over the age of 65 years. The imposed outflow obstruction leads to left ventricular hypertrophy (LVH), which is a well-recognized risk factor for multiple adverse clinical outcomes, including sudden death, myocardial infarction, stroke, congestive heart failure, and cardiovascular-related mortality. 2 A major goal of aortic valve replacement (AVR) is to remove the outflow obstruction, reduce the pressure load, and facilitate regression of ventricular hypertrophy. The completeness of LV mass regression is a ma-
European Journal of Cardio-Thoracic Surgery, 2006
Objective: To report on the midterm results of aortic valve replacement (AVR) with stented and stentless bioprosthesis in an elderly population by analyzing the factors affecting survival and hemodynamical performance. Methods: In a retrospective study, 145 patients with a Toronto stentless prosthesis are compared with 110 patients with a stented Carpentier-Edwards valve. The 5-to 10-year clinical outcome, transprosthetic gradients, and early and late left ventricular mass (LVM) regression are analyzed in view of specific prosthesis-and patient-related factors. Results: Actuarial survival at 5 years is 82% after stentless AVR versus 68% after stented AVR ( p < 0.001) in elderly patients. However, there was no difference in survival at 8 years, being 55.9% and 59.5%, respectively. Univariate analysis revealed that advanced age at the time of operation, NYHA class IV, use of a stented xenograft, presence of patient-prosthesis mismatch (PPM) (IEOA 0.85 cm 2 /m 2 ), and severe preoperative left ventricular (LV) hypertrophy (LVMI > 180 g/m 2 ) affected survival adversely. But multivariate analysis determined only age, NYHA class IV and excessive LV hypertrophy as independent predictors of late mortality. Stented and stentless xenografts were equally effective in terms of transprosthetic gradients and LVMI regression. The use of a stentless valve significantly reduced the occurrence of PPM (18% vs 41%, p < 0.01). Early LVMI regression at 1 year was optimized by the avoidance of PPM, indicated by a higher absolute (43.7 AE 28.3 g/m 2 vs 58.6 AE 33.8 g/m 2 , p = 0.003) and relative (25.0 AE 12.7% vs 31.4 AE 14.9%, p = 0.004) mass regression. However, late LV remodeling was predominantly affected by systemic hypertension and severe preoperative LV hypertrophy, resulting in the incomplete LVMI resolution in 61.3% and 66.7% of these patients, respectively. Conclusion: In elderly patients, aortic valve replacement appears to be equally effective with a stentless or stented bioprosthesis. Midterm clinical outcome is mainly determined by patient-related factors such as age, advanced NYHA class, and severity of preoperative LV hypertrophy. Regarding post-AVR left ventricular remodeling, patient-prosthesis mismatch influences the early phase, whereas arterial hypertension affects the late regression more. However, the left ventricular remodeling is continuously compromised by the preoperative presence of excessive hypertrophy, despite the efficacy of the aortic valve replacement. #
Interactive cardiovascular and thoracic surgery, 2007
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a stentless valve is superior to conventional stented valves when tissue aortic valve replacement is performed. Altogether more than 515 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that stentless valves allow a larger effective orifice area valve to be implanted with a lower mean and peak aortic gradient postoperatively. At six months several studies and a meta-analysis have shown superior left ventricular mass regression in the stentless valve groups. However, by 12 months the stented valve groups catch up in terms of mass regression and this significance disappears. So the 'eminent speaker from the floor', was right ...
The Journal of thoracic and cardiovascular surgery, 2016
Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR (P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 m...