title: Midterm survival of stented versus stentless valves: does concomitant coronary artery bypass grafting impact survival?
abstract: The purpose of this study was to examine the impact of concomitant coronary artery bypass grafting (CABG) and valve design on survival following aortic valve replacement (AVR) with stentless and stented bioprostheses. Survival data for 1798 patients undergoing AVR between 1991 and 1997 with either a stentless (Medtronic Freestyle = 700, Toronto SPV = 447; N = 1147) or stented (Hancock II = 224, Carpentier-Edwards SAV = 427; N = 651) valve were analyzed. Bivariable analyses using Kaplan-Meier survival curves and log-rank test were performed to compare survival probabilities by valve type. Multivariable stepwise Cox's proportional hazard models were used to control for potentially confounding variables. Concomitant CABG was performed in 41% of stentless and 46% of stented patients (P =.04). Survival probability at 5 years was 0.84 (95% CI = 0.81, 0.87) for stentless versus 0.79 (95% CI = 0.75, 0.83) for stented patients (P =.004). In the absence of concomitant CABG, survival was superior in stentless (0.84) over stented (0.80) patients, but these differences were not statistically significant (P =.053). In patients that underwent AVR with concomitant CABG, survival was significantly better in stentless patients (0.82) than in stented individuals (0.77, P =.049). The unadjusted hazard ratio for stented versus stentless was 1.44 (95% CI = 1.12, 1.86, P =.005). In the final Cox's proportional hazard model the variables that effected survival were valve type and age in decades. New York Heart Association class at the time of surgery had a marginal effect on survival. The data demonstrate improved midterm survival with stentless versus stented valves. Subgroup analysis suggests survival benefits of stentless valves may be greater in patients who undergo concomitant CABG surgery.
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: D F
authors.initials: DF
authors.lastname: Del Rizzo
authors.forename: D
authors.initials: D
authors.lastname: Freed
authors.forename: A
authors.initials: A
authors.lastname: Abdoh
authors.forename: D
authors.initials: D
authors.lastname: Doty
authors.forename: B S
authors.initials: BS
authors.lastname: Goldman
authors.forename: W R
authors.initials: WR
authors.lastname: Jamieson
authors.forename: S
authors.initials: S
authors.lastname: Westaby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D016019:Survival Analysis