Comparison of late outcome after stentless versus stented xenograft aortic valve replacement.
The long-term outcomes of 292 patients having stented xenograft aortic valve replacement (AVR) (group 1) and 376 having stentless AVR (group 2) were compared. Patients in group 1 were older (75 +/- 9 years v 70 +/- 6 years, P =.01), had more advanced cardiac disease (New York Heart Association [NYHA] classification III-IV: 85% v 75%, P =.03), and more associated procedures (53% v 41%, P =.01). Early mortality was higher in Group 1 (6.2% v 2.6%, P =.02), primarily due to cardiac cause (5.4% v 1.5%, P =.009). During follow-up (37 +/- 30 months v 43 +/- 35 months, P = not significant [ns]), 66 late deaths were recorded (12% v 9%, P = ns). At 8 years, survival (70% +/- 5% v 81% +/- 3%, P =.01) freedom from cardiac death (85% +/- 1% v 92% +/- 3%, P =.02) and prosthesis-related death (79% +/- 5% v 95% +/- 2%, P =.004) was higher in Group 2, but freedom from structural deterioration was similar (92% +/- 5% v 93% +/- 3%, P = ns). Late functional status was equally satisfactory (NYHA classification I-II: 89% v 90%, P = ns). Stentless AVR may confer selective survival advantages. Because freedom from valve failure is similar to stented xenografts, extension of stentless AVR to patients without anatomic contraindications appears justified.
Luciani
G B
GB
Division of Cardiac Surgery, University of Verona, Verona, Italy.
Auriemma
S
S
Santini
F
F
Casali
G
G
Barozzi
L
L
Mazzucco
A
A
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011474:Prosthesis Design; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome