Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic Root

Wollersheim, Laurens W.; Li, Wilson W.; Kaya, Abdullah; Bouma, Berto J.; Driessen, Antoine H.G.; Boven, Wim Jan van; Meulen, Jan van der; Mol, Bas A.J.M. de

doi:10.1053/j.semtcvs.2016.02.012

Cited by 19 publications

(19 citation statements)

References 18 publications

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“…In addition to lower profile supra-annular valves, stentless valves have also been proposed as a means of reducing the incidence of PPM, particularly in those with small aortic roots 38. Given that one of the post hoc findings of the Placement of Aortic Transcatheter Valves (PARTNER) trial was the lower incidence of PPM after transcatheter AVR (TAVR) compared with SAVR,39 this is now an area of increasing interest.…”

Section: Prevention Of Ppmmentioning

confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

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Section: Prevention Of Ppmmentioning

confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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“…1,2 Several papers are available in the literature comparing results after aortic valve replacement using stented versus stentless bioprostheses [3][4][5] , where the majority of these reported outcomes after follow-up times of 10 years or shorter, and compared the CEP or the CEP Magna to the Freedom Solo valve. [6][7][8][9] To the best of our knowledge this is the first report analyzing long-term outcomes of SPF valve versus CEP by a case-matched analysis.…”

Section: Discussionmentioning

confidence: 97%

Stentless Pericarbon Freedom Versus Stented Perimount Aortic Bioprosthesis: Propensity-Matched Long-Term Follow-Up

Stefanelli

Pirro

Smorto

et al. 2020

Innovations�(Phila)

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Objective Stentless aortic valves have shown superior hemodynamic performance and faster left ventricular mass regression compared to stented bioprostheses. Yet, controversies exist concerning the durability of stentless valves. This case-matched study compared short- and long-term clinical outcomes of stentless LivaNova-Sorin Pericarbon Freedom™ (SPF) and stented Carpentier-Edwards Perimount (CEP) aortic prostheses. Methods From 2003 through 2006, 134 consecutive patients received aortic valve replacement with SPF at our institution. This cohort was matched, according to 20 preoperative clinical parameters, with a control group of 390 patients who received CEP prosthesis during the same time. The resulting 55 + 55 matched patients were analyzed for perioperative results and long-term clinical outcomes. Results Early mortality was 0% for both groups. Lower transvalvular gradients were found in the SPF group (10.6 ± 2.9 versus 15.7 ± 3.1 mmHg, P < 0.001). Overall late mortality (mean follow-up: 10.03 years) was similar for both groups (50.1% versus 42.8%, P = 0.96). Freedom from structural valve degeneration (SVD) at 13 years was similar for both groups (SPF = 92.3%, CEP = 73.9%, P = 0.06). Freedom from aortic valve reinterventions did not differ (SPF = 92.3%, CEP = 93.5%, P = 0.55). Gradients at 13-year follow-up remained significantly lower in SPF group (10.0 ± 4.5 versus 16.2 ± 9.5 mmHg, P < 0.001). Incidence of acute bacterial endocarditis (ABE) and major adverse cardiovascular and cerebrovascular events (MACCE) was similar. Conclusions SPF and CEP demonstrated comparable long-term outcomes related to late mortality, SVD, aortic valve reinterventions, and incidence of ABE and MACCE. Superior hemodynamic performance of SPF over time can make this valve a suitable choice in patients with small aortic root and large body surface area.

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“…The author has received no funding relevant to this work In a paper published in this issue of the Seminars, the group of Wollersheim et al, 1 …”

Section: Fundingmentioning

confidence: 99%