The Edwards Prima stentless valve: hemodynamic performance at one year

Bortolotti, Uberto; Scioti, Giovanni; Milano, Aldo Domenico; Borzoni, G; Nardi, Carmela; Tartarini, Giuseppe

doi:10.1016/s0003-4975(99)00830-9

Cited by 12 publications

(13 citation statements)

References 14 publications

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“…First-generation stentless bioprostheses were the Freestyle valve4 (Medtronic, Minneapolis, MN) and the Prima valve5 (Edwards Lifesciences, Irvine, CA) as well as a porcine root and fully scalloped Toronto stentless porcine valve (SPV)6 (St Jude Medical, Minneapolis, MN). The O’Brien porcine stentless valve7 (CryoLife, Atlanta, GA) and Biocor porcine bioprosthesis (Biocor Industria e Pesquisa, Belo Horizonte, MG, Brazil)8 were also introduced to the market, but have not found widespread acceptance.…”

Section: Various Stentless Bioprostheses and Implantation Techniquementioning

confidence: 99%

“…Implantation technique was also related to the improved hemodynamics. A full-root technique can implant a larger stentless valve in the supra-annular position, allowing upsizing, compared with the original aortic annulus 58,59. There may be a bias in the selection of stentless or stented valves by surgeons, because more complicated aortic root anatomy leads to the more frequent selection of stented valves in the learning curve period.…”

Section: Hemodynamic Advantagesmentioning

confidence: 99%

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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: Various Stentless Bioprostheses and Implantation Techniquementioning

confidence: 99%

Section: Hemodynamic Advantagesmentioning

confidence: 99%

Stentless aortic valve replacement: an update

Kobayashi

2011

VHRM

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“…Another possible explanation is that the hemodynamic superiority of stentless valves was not fulfi lled in the small sizes (19-23 mm). 9,11,14 In our series, when analyzing the implanted diameter, stentless valves with diameters of <25 mm were implanted in about 90% of patients. Therefore, it may be possible that we could not obtain superior results.…”

Section: Discussionmentioning

confidence: 88%

“…Previous reports of Edwards Prima stentless valves have shown satisfactory results, with low hospital mortality and a low incidence of postoperative complications. [9][10][11] It has been recognized that stentless valves have superior hemodynamic performance in that they maximize the area for blood fl ow across the valve. Despite their benefi ts, the use of stentless valves for AVR has not become common.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly high gradients have been reported by other investigators. [9][10][11]14 These reports suggested that such elevated gradients may be, at least in part, explained by the peculiar design of the Edwards Prima stentless bioprosthesis, which is provided with a high external Dacron fabric cloth below the right coronary ostium. When suturing the inferior rim of the prosthetic right coronary ostium below the patient's right coronary ostium, inward folding of the Dacron fabric occurs, creating a fi xed obstacle to left ventricular outfl ow at the valvular level; this was observed in two of the patients included in this series.…”

Section: Discussionmentioning

confidence: 99%

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