title: Are stentless valves superior to modern stented valves? A prospective randomized trial.
abstract: BACKGROUND
  It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves.
  
  
  RESULTS
  Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patients, MRI was also used to assess LVM regression, and again there was no significant difference between groups at 1 year. Hemodynamic performance of the 2 valves was similar with no difference in mean and peak systolic transvalvular gradients 1 year after surgery. In patients with reduced ventricular function (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients.
  
  
  CONCLUSIONS
  Both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR. Comparable hemodynamics and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. In patients with ventricular impairment, stentless bioprostheses may allow for greater improvement in left ventricular function postoperatively.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK.
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: James C
authors.initials: JC
authors.lastname: Halstead
authors.forename: Fay
authors.initials: F
authors.lastname: Cafferty
authors.forename: Linda
authors.initials: L
authors.lastname: Sharples
authors.forename: Fiona
authors.initials: F
authors.lastname: Rose
authors.forename: Richard
authors.initials: R
authors.lastname: Coulden
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Dunning
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Argano
authors.forename: Steven
authors.initials: S
authors.lastname: Tsui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D015607:Stents; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography