Retrospective clinical analysis of stented vs. stentless porcine aortic bioprostheses✩

Vrandecic, Mário Osvaldo; Fantini, Fernando Antônio; Filho, Bayard Gontijo; Oliveira, O Cesar de; Júnior, Idail Martins da Costa; Vrandecic, Erika Correa

doi:10.1016/s1010-7940(00)00416-4

Cited by 30 publications

(16 citation statements)

References 17 publications

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“…Only Vrandecic et al18 reported the better durability of Biocor stentless bioprostheses than of its counterparts in patients with a mean age of 48.1 years and 46.1 years. Although long-term results of homograft aortic valves are excellent, faster calcification in homografts has been reported compared with Freestyle stentless valves in a younger age group 72…”

Section: Degeneration and Durabilitymentioning

confidence: 99%

Stentless aortic valve replacement: an update

Kobayashi

2011

VHRM

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Although porcine aortic valves or pericardial tissue mounted on a stent have made implantation techniques easier, these valves sacrifice orifice area and increase stress at the attachment of the stent, which causes primary tissue failure. Optimizing hemodynamics to prevent patient–prosthetic mismatch and improve durability, stentless bioprostheses use was revived in the early 1990s. The purpose of this review is to provide a current overview of stentless valves in the aortic position. Retrospective and prospective randomized controlled studies showed similar operative mortality and morbidity in stented and stentless aortic valve replacement (AVR), though stentless AVR required longer cross-clamp and cardiopulmonary bypass time. Several cohort studies showed improved survival after stentless AVR, probably due to better hemodynamic performance and earlier left ventricular (LV) mass regression compared with stented AVR. However, there was a bias of operation age and nonrandomization. A randomized trial supported an improved 8-year survival of patients with the Freestyle or Toronto valves compared with Carpentier–Edwards porcine valves. On the contrary, another randomized study did not show improved clinical outcomes up to 12 years. Freedom from reoperation at 12 years in Toronto stentless porcine valves ranged from 69% to 75%, which is much lower than for Carpentier–Edwards Perimount valves. Cusp tear with consequent aortic regurgitation was the most common cause of structural valve deterioration. Cryolife O’Brien valves also have shorter durability compared with stent valves. Actuarial freedom from reoperation was 44% at 10 years. Early prosthetic valve failure was also reported in patients who underwent root replacement with Shelhigh stentless composite grafts. There was no level I or IIa evidence of more effective orifice area, mean pressure gradient, LV mass regression, surgical risk, durability, and late outcomes in stentless bioprostheses. There is no general recommendation to prefer stentless bioprostheses in all patients. For new-generation pericardial stentless valves, follow-up over 15 years is necessary to compare the excellent results of stented valves such as the Carpentier–Edwards Perimount and Hancock II valves.

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Section: Degeneration and Durabilitymentioning

confidence: 99%

Stentless aortic valve replacement: an update

Kobayashi

2011

VHRM

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“…Previous investigators have demonstrated the excellent results obtained with stentless bioprostheses 18–20 . Stentless bioprostheses have better hemodynamic performance both at rest and during exercise than stented bioprostheses 2–4 . However, less is known about their results in small aortic annulus.…”

Section: Discussionmentioning

confidence: 99%

“…Freestyle stentless bioprostheses have shown excellent hemodynamic performance, transvalvular gradients are significantly lower, and EAO is significantly higher with stentless bioprostheses compared to stented bioprostheses. 2,3 Furthermore, our group has shown better hemodynamic performance during exercise with stentless aortic valves compared to stented valves. 4 However, small size subcoronary stentless implants have yet to prove their clinical usefulness.…”

mentioning

confidence: 86%

Does the Use of Stentless Aortic Valves in a Subcoronary Position Prevent Patient-Prosthesis Mismatch for Small Aortic Annulus?

Lopez¹,

Mathieu²,

Pîbarot

et al. 2008

Journal of Cardiac Surgery

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“…The Magna valve showed superior hemodynamics when compared in a prospective randomized fashion to Edwards Prima stentless valve [24]. Stentless valves in general, however, have shown better hemodynamics when compared to other stented bioprosthetic and mechanical valves [25,40].…”

Section: Hemodynamics and Small Aortic Annulusmentioning

confidence: 93%

Heart valve replacement: Which valve for which patient?

Huh

Bakaeen²

2006

Curr Cardiol Rep

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The ideal heart valve substitute would show no deterioration or thrombogenicity, offer no resistance to blood flow, and be easy to implant. However, such a valve does not exist and we must accept compromises in some of these qualities based on our patients' needs. In selection of cardiac valve prosthesis, valve-related factors such as durability, thrombogenicity, and fluid dynamics should be carefully matched to patient-related factors such as age, size, life expectancy, comorbidities, plans for pregnancy, and lifestyle. In addition, surgeon- or operation-related factors should be considered. Technical aspects of implantation, ease of reoperation, and operative mortalities may tip the risk and benefit balance in a particular direction. We review currently available heart valve prostheses and the clinical factors that are involved in selection of a heart valve substitute.

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Retrospective clinical analysis of stented vs. stentless porcine aortic bioprostheses✩

Cited by 30 publications

References 17 publications

Stentless aortic valve replacement: an update

Stentless aortic valve replacement: an update

Does the Use of Stentless Aortic Valves in a Subcoronary Position Prevent Patient-Prosthesis Mismatch for Small Aortic Annulus?

Heart valve replacement: Which valve for which patient?

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