Are Stentless Valves Superior to Modern Stented Valves?

Ali, Ayyaz; Halstead, James C.; Cafferty, Fay; Sharples, Linda D.; Rose, Fiona; Coulden, Richard; Lee, Evelyn; Dunning, John; Argano, Vincenzo; Tsui, Steven

doi:10.1161/circulationaha.105.000950

Cited by 59 publications

(65 citation statements)

References 13 publications

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“…Recently, Ali et al [16] reported, in a prospective randomized trial, that both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR, and that, in patients with ventricular impairment, stentless valves could allow for greater improvement of left ventricular function postoperatively. It should, however, be emphasized that stentless bioprostheses are usually more difficult to suture in these elderly patients with often calcified Valsalva sinus and, therefore, require a longer clamping time than stented prostheses.…”

Section: Long-term Survival and Quality Of Lifementioning

confidence: 99%

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

117

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long-term results Aortic valve surgery in octogenarians: predictive factors for operative and This information is current as of April 2, 2007http://ejcts.ctsnetjournals.org/cgi/content/full/31/4/600 located on the World Wide Web at:The online version of this article, along with updated information and services, is AbstractObjective: To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 AE 5.2 and 6.9 AE 3.4 days, respectively. Multivariate predictors ( p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 AE 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent. #

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Section: Long-term Survival and Quality Of Lifementioning

confidence: 99%

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

117

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“…They found no signifi cant differences in transvalvular gradients or the LVM index. 16 The negative results of this trial might be attributed to the excellent hemodynamics of the new generation stented valves and the lack of more sensitive measures to detect subtle differences between the modern low-profi le stentless and stented valves.…”

Section: Discussionmentioning

confidence: 97%

Hemodynamic performance of the Edwards Prima Plus stentless valve at 1 year

Tanaka

Kinoshita

Fujinaga

et al. 2008

Gen Thorac Cardiovasc Surg

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“…Although they demonstrate excellent hemodynamic performance, their implantation is more demanding implantation procedure and the longterm durability remains limited. 10,11) In contrast, conventional stented valves, exhibiting a proven durability, are simple to implant, while their hemodynamic performance is limited by the stent, which narrows the orifice area. The last generation of stentless and stented pericardial aortic bioprostheses is characterized by supra-annular implantation.…”

Section: Discussionmentioning

confidence: 99%

“…The disadvantage of a demanding implantation procedure of the first generation of stentless valves, which resulted in prolonged procedural times, 10,11) disappeared due to the simplified single suture line implantation technique of the SFS 9) leading to shorter procedural times. In contrast, the LDP valves were associated with prolonged implantation time in our series.…”

Section: Discussionmentioning

confidence: 99%