Stentless valves for aortic valve replacement: where do we stand?
OBJECTIVE
Following more than a decade's experience with stentless valves and the development of better profiled stented valves, the article discusses the advantages of stentless valves regarding hemodynamic performance, left ventricular mass regression, durability and survival.


RESULTS
Recent studies show that stentless valves remain hemodynamically superior compared with modern porcine stented valves. This superiority is, however, rarely reported in comparison with modern pericardial stented valves. In general, patient-prosthesis mismatch is less frequent in stentless vs. stented valves. Recent randomized trials comparing stentless valves and modern stented valves show equivalent left ventricular mass regression at 1 year. At 10 years, stentless valve durability is excellent and comparable with that of stented valves. Recent comparative studies do not confirm the previously reported midterm survival advantages of stentless valves.


CONCLUSIONS
Improvement of stented valves has significantly reduced the hemodynamic differences between them and their stentless counterpart. Patients with small aortic annulus, however, should benefit from a stentless valve due to the better expected gradients and lower risk of patient-prosthesis mismatch. Midterm results suggest equivalent durability and survival for both prosthesis types but additional and longer-term trials are necessary to confirm these results.
de Kerchove
Laurent
L
Department of Cardiology, Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Brussels, Belgium.
Glineur
David
D
El Khoury
Gebrine
G
Noirhomme
Philippe
P
D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D004389:Durable Medical Equipment; D004867:Equipment Design; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D018570:Risk Assessment; D015607:Stents; D013318:Stroke Volume; D016277:Ventricular Function, Left