Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis.
OBJECTIVE
In some randomized studies, stentless aortic valves have demonstrated hemodynamic advantages in comparison with stented prostheses. The effect of more physiologic flow dynamics on coronary artery flow has not been investigated yet. This study compares coronary perfusion after aortic valve replacement with stented or stentless porcine bioprostheses in a prospective randomized study.


METHODS
A total of 24 patients (73 +/- 6 years) referred for treatment of aortic stenosis were randomized to aortic valve replacement with stented (Medtronic Mosaic; (Medtronic Inc, Minneapolis, Minn) or stentless (Medtronic Freestyle; Medtronic Inc) prostheses. Coronary flow was measured by means of magnetic resonance imaging preoperatively, 5 days after the operation, and 6 months postoperatively, then with evaluation of coronary flow reserve. Echocardiography was performed to quantify transvalvular gradients and left ventricular mass regression.


RESULTS
Coronary flow increased in both groups significantly (P < .001) after aortic valve replacement. This increase was higher in the stentless group compared with that seen in the stented group (343 +/- 137 vs 221 +/- 66 mL/min). Also, coronary flow reserve was higher for stentless valves (3.4 +/- 0.3 for stentless valves and 2.3 +/- 0.1 for stented valves). Mean pressure gradients for Freestyle valves were lower (10 +/- 4 and 8 +/- 3 mm Hg, respectively, vs 19 +/- 6 postoperatively and 15 +/- 4 mm Hg at follow-up for Mosaic valves, P < .05). Left ventricular mass regression was similar in both groups.


CONCLUSIONS
Normalization of coronary artery flow after aortic valve replacement for aortic stenosis was more pronounced for stentless valves compared with stented valves. The fact that the stentless design also demonstrated a superior hemodynamic performance with lower pressure gradients might be explained by the design being closer to physiologic anatomy and thus the presence of lower turbulence levels in the sinuses of Valsalva.
Bakhtiary
Farhad
F
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany. farhad@bakhtiary.de
Schiemann
Mirko
M
Dzemali
Omer
O
Wittlinger
Thomas
T
Doss
Mirko
M
Ackermann
Hans
H
Moritz
Anton
A
Kleine
Peter
P
D000368:Aged; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D003331:Coronary Vessels / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012039:Regional Blood Flow; D015607:Stents