Stentless valves for aortic valve replacement: where do we stand?

Abstract

Improvement of stented valves has significantly reduced the hemodynamic differences between them and their stentless counterpart. Patients with small aortic annulus, however, should benefit from a stentless valve due to the better expected gradients and lower risk of patient-prosthesis mismatch. Midterm results suggest equivalent durability and survival for both prosthesis types but additional and longer-term trials are necessary to confirm these results.

Freedom SOLO valve: early- and intermediate-term results of a single centre's first 100 cases

“…The development of new stented valves has significantly reduced the haemodynamic differences between them and their stentless counterparts except for patients with small aortic annulus [8,9]. Theoretically, the absence of a stent should provide more space available for blood flow and result in lower transvalvular gradients and larger effective orifice areas.…”

Single-center experience using the Freedom SOLO aortic bioprosthesis

“…As aortic valve prosthesis design has evolved, the development of new stented valves has significantly reduced the hemodynamic differences between them and their stentless counterparts, except for patients with a small aortic annulus. 7,8 This is of extreme importance when calcific aortic valve stenosis with a small annulus, which is prevalent in the elderly, is taken into consideration, because this population is at higher risk for patient-prosthesis mismatch. The Freedom SOLO bioprosthesis is a pericardial stentless valve with a design and implantation technique that make it an ideal choice for AVR in this population.…”

Bioprosthetic replacement of the ascending thoracic aorta: what are the options?

“…However, whether these hemodynamic advantages translate into reduced postoperative morbi-mortality and improve late survival still remains controversial [22]. Nevertheless, these putative advantages have also prompted the use of stentless bioprostheses for the construction of composite valved conduits for bioprosthetic replacement of the ascending aorta.…”