Original article: cardiovascularSurvival advantage of stentless aortic bioprostheses
Section snippets
Patients and methods
The study aim was to determine differences in outcome between hospital survivors with stented and stentless bioprostheses. We investigated late postoperative morbid events and longevity in concurrent series of patients undergoing aortic valve replacement with the Freestyle stentless xenograft (FSV; Medtronic Inc, Minneapolis, MN) from July 1993 to June 1997, and the Carpentier-Edwards (CE) SAV bioprosthesis model 2650 (Baxter Health Care Inc, Irvine, CA) from January 1992 to February 1998. Both
Results
Analysis of preoperative data showed the FSV patients to be sicker (NYHA class III/IV, FSV 73%, CE 46%; p < 0.01) with a greater incidence of renal impairment (Creatinine > 140 mg/dL; FSV 36%, CE 18%; p < 0.01) (Table 1). This may reflect the cardiologists’ referral practice, because in every other respect the patients were closely matched. Sizes of prostheses implanted (reflecting annulus size) were also comparable (Table 2). There was no significant difference in operative mortality between
Limitations of the study
This was not a prospective randomized trial, but a comparative study, which describes the outcome in concurrent groups of hospital survivors who received a stented or stentless porcine xenograft at the same center. However, in contrast to the small number of randomized trials, our patients were not selected as favorable candidates for the stentless valve 9, 10. Paradoxically, sicker patients were referred to the surgeon who used stentless valves and could have biased survival against this
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Long-term clinical outcomes 15 years after aortic valve replacement with the freestyle stentless aortic bioprosthesis
2014, Annals of Thoracic SurgeryClinical evaluation of new heart valve prostheses: Update of objective performance criteria
2014, Annals of Thoracic SurgerySurgery for Valvular Heart Disease
2012, Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease: Fourth EditionWhich Patients Benefit From Stentless Aortic Valve Replacement?
2009, Annals of Thoracic Surgery2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease)
2008, Journal of the American College of CardiologyMidterm Outcomes of Stented Versus Stentless Bioprosthetic Valves After Aortic Root Replacement
2022, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Various bioprosthetic valves are commercially available, with some being reinforced by an alloyed stent, while others remain stentless,8-14 including homografts and some xenografts, with each harboring their own advantages and disadvantages.15-25 By reproducing natural physiologic conditions, some proponents believe that stentless bioprosthetic valves may optimize postoperative survival, compared to all other commercially available valves; however, a survival benefit has yet to be demonstrated.26-34 Currently, there is little consensus as to the optimal bioprosthetic aortic valve.