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. 2022 Sep;114(3):728-734.
doi: 10.1016/j.athoracsur.2022.01.029. Epub 2022 Feb 10.

Stentless Versus Stented Aortic Valve Replacement for Aortic Stenosis

Bo Yang  1 , Alexander Makkinejad  2 , Shinichi Fukuhara  2 , Jeffrey Clemence Jr  2 , Linda Farhat  2 , Aroosa Malik  2 , Xiaoting Wu  2 , Karen Kim  2 , Himanshu Patel  2 , G Michael Deeb  2
Affiliations

Stentless Versus Stented Aortic Valve Replacement for Aortic Stenosis

Bo Yang et al. Ann Thorac Surg. 2022 Sep.

Abstract

Background: The differences in long-term outcomes of aortic valve replacement for aortic stenosis between stentless and stented bioprostheses are controversial.

Methods: Between 2007 and 2018, 1173 patients underwent aortic valve replacement for aortic stenosis, including 559 treated with a stentless valve and 614 with a stented valve. A propensity score matched cohort with 348 pairs was generated by matching for age, sex, body surface area, bicuspid aortic valve, chronic lung disease, previous cardiac surgery, coronary artery disease, renal failure on dialysis, valve size, concomitant procedures, and surgeon. The primary endpoints of the study were long-term survival and incidence of reoperation.

Results: Immediate postoperative outcomes were similar between the stentless and stented groups with an overall operative mortality of 2.9% (P = .19). Kaplan-Meier estimation for long-term survival was comparable between the stentless and stented valves in both the whole cohort and the propensity score matched cohort (10-year survival 59% vs 55%, P = .20). The hazard ratio of stentless vs stented valve for risk of long-term mortality was 1.12 (P = .33). The 10-year cumulative incidence of reoperation due to valve degeneration was 5.5% in the stentless group and 4.7% in the stented group (P = .25). The transvalvular pressure gradient at 5-year follow-up was significantly lower in the stentless group (7 vs 11 mm Hg, P < .001).

Conclusions: Both stented and stentless valves could be used in aortic valve replacement for aortic stenosis. We recommend stented valves for aortic valve replacement in patients with aortic stenosis for their simplicity of implantation.

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Conflict of interest statement

Disclosure Statement: The authors declare that they have no conflicts of interest relating to this study.

Figures

Figure 1:
Figure 1:
Kaplan-Meier analysis of survival of stentless vs. stented valve in the entire cohort (A) and propensity score matched patients using the variables: age, body surface area, valve size, sex, bicuspid aortic valve, chronic obstructive pulmonary disease, previous cardiac surgery, coronary artery disease, renal failure on dialysis, concomitant procedures, and surgeon (B). 5-year survival was 82% in the stented valve group and 84% in the stentless valve group of the whole cohort.
Figure 1:
Figure 1:
Kaplan-Meier analysis of survival of stentless vs. stented valve in the entire cohort (A) and propensity score matched patients using the variables: age, body surface area, valve size, sex, bicuspid aortic valve, chronic obstructive pulmonary disease, previous cardiac surgery, coronary artery disease, renal failure on dialysis, concomitant procedures, and surgeon (B). 5-year survival was 82% in the stented valve group and 84% in the stentless valve group of the whole cohort.
Figure 2:
Figure 2:
Cumulative incidence (CI) of reoperation after implantation of either a stented or stentless aortic valve adjusting for death and reoperation for non-valve related reasons showed no difference between stented and stentless valves (p=0.25).
Figure 3:
Figure 3:
Annual distribution of stentless versus stented valve usage at our institution.
See this image and copyright information in PMC

Comment in

  • Stentless Aortic Valves: Quo Vadis?
    Williams EE, El-Hamamsy I. Williams EE, et al. Ann Thorac Surg. 2022 Sep;114(3):734-735. doi: 10.1016/j.athoracsur.2022.02.049. Epub 2022 Mar 12. Ann Thorac Surg. 2022. PMID: 35288082 No abstract available.

References

    1. Kunadian B, Vijayalakshmi K, Thornley AR, de Belder MA, Hunter S, Kendall S, et al. Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves. Ann Thorac Surg. 2007;84:73–9. - PubMed
    1. Pepper J, Cheng D, Stanbridge R, et al. Stentless versus stented bioprosthetic aortic valves: a systematic review and meta-analysis of controlled trials. Innovations. 2009;4:61–73. - PubMed
    1. Van der Straaten EP, Rademakers LM, van Straten AH, et al. Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis. Eur J Cardiothorac Surg. 2016;49:1174–1180. - PubMed
    1. Harky A, Wong CHM, Hof A, et al. Stented versus Stentless Aortic Valve Replacement in Patients with Small Aortic Root: A Systematic Review and Meta-Analysis. Innovations. 2018;13:404–416. - PubMed
    1. Bach DS, Patel HJ, Kolias TJ, Deeb GM. Randomized comparison of exercise haemodynamics of Freestyle, Magna Ease and Trifecta bioprostheses after aortic valve replacement for severe aortic stenosis. Eur J Cardiothorac Surg. 2016;50(2):361–367. - PubMed