Stentless vs. stented bioprosthesis for aortic valve replacement: A case matched comparison of long-term follow-up and subgroup analysis of patients with native valve endocarditis

Abstract

BackgroundCurrent retrospective evidence suggests similar clinical and superior hemodynamic outcomes of the Sorin Freedom Solo stentless aortic valve (SFS) (LivaNova PLC, London, UK) compared to the Carpentier Edwards Perimount stented aortic valve (CEP) (Edwards Lifesciences Inc., Irvine, California, USA). To date, no reports exist describing case-matched long-term outcomes and analysis for treatment of native valve endocarditis (NVE).MethodsFrom 2004 through 2014, 77 consecutive patients (study group, 59.7% male, 68.9 ± 12.5 years, logEuroSCORE II 7.6 ± 12.3%) received surgical aortic valve replacement (SAVR) with the SFS. A control group of patients after SAVR with the CEP was retrieved from our database and matched to the study group regarding 15 parameters including preoperative endocarditis. Acute perioperative outcomes and follow-up data (mean follow-up time 48.7±29.8 months, 95% complete) were retrospectively analyzed.ResultsNo differences in early mortality occurred during 30-day follow up (3/77; 3.9% vs. 4/77; 5.2%; p = 0.699). Echocardiographic findings revealed lower postprocedural transvalvular pressure gradients (max. 17.0 ± 8.2 vs. 24.5 ± 9.2 mmHg, p< 0.001/ mean pressure of 8.4 ± 4.1 vs. 13.1 ± 5.9 mmHg, p< 0.001) in the SFS group. Structural valve degeneration (SVD) (5.2% vs. 0%; p = 0.04) and valve explantation due to SVD or prosthetic valve endocarditis (PVE) (9.1% vs. 1.3%; p = 0.04) was more frequent in the SFS group. All-cause mortality during follow-up was 20.8% vs. 14.3% (p = 0.397). When patients were divided into subgroups of NVE and respective utilized bioprosthesis, the SFS presented impaired outcomes regarding mortality in NVE cases (p = 0.031).ConclusionsThe hemodynamic superiority of the SFS was confirmed in this comparison. However, clinical outcomes in terms of SVD and PVE rates, as well as survival after NVE, were inferior in this study. Therefore, we are reluctant to recommend utilization of the SFS for treatment of NVE.

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

“…The major findings of this review noted that surgical correction of aortic valve endocarditis ranged around 55% per year and in high-income nations, most of the patients involved were >60 years. There is a general preference for biological prostheses 18,26,31 as the primary intervention over mechanical prostheses 27,115 and homografts or autograft. 28,32,34,47 Aortic valve repair is indicated in selected cases and the use of the TAVR is not recommended in current guidelines.…”

Solo Smart Stentless Bioprosthesis for Infective Valve Endocarditis with Aortic Annular Abscess

“…Therefore, better outcomes with the SS stentless valve depend on optimal patient selection and on recognizing its limitations. 8,11) In conclusion, high-risk patients with infective endocarditis accompanied by annular abscess, a small aortic annulus, and those who require concomitant mitral valve surgery and redo AVR may profit from SS stentless valve implantation.…”

“…6) Recently, the FS bovine pericardial stentless valve has been used for the surgical treatment of infective endocarditis. [7][8][9] A recent multicenter study showed the surgical results of 59 patients with extensive infective endocarditis who underwent AVR with the FS bovine pericardial stentless valve. 7) All patients in this study presented with annular tissue infection, and 54.3% of them had annular abscess.…”

“…10) Conversely, Schaefer et al reported that the survival of patients who underwent AVR using the FS bovine pericardial stentless valve for native valve endocarditis and the clinical outcomes in terms of structural valve deterioration and prosthetic valve endocarditis rates were inferior compared with the stented pericardial valve. 8) Although patients with extensive annular damage may benefit from the supra-annular implantation technique, the authors were reluctant to recommend its utilization for the treatment of native valve endocarditis.…”

Biomaterials in Valvular Heart Diseases

“…However, while the implantation of stented BPHVs is easier, especially through the small aortic root, surgical implantation of stentless valves is more difficult and time-consuming. In a recent study by Schaefer and colleagues, superior hemodynamic characteristics of stentless aortic valves in comparison to a stented aortic valve was confirmed, however, the rate of SVD occurrence and subsequent endocarditis was higher in patients who received stentless valves (Schaefer et al, 2018).…”