Stented versus stentless bioprostheses in aortic valve stenosis: effect on left ventricular remodelling.
BACKGROUND
Whether the use of stentless aortic bioprostheses improves hemodynamics more than stented bioprostheses in the small aortic root is still a matter of debate.


METHODS
Early- and mid-term effects were compared between 2 different types of stentless bioprotheses and 1 type of stented bioprosthesis for left ventricular remodelling. The effects of the bioprotheses were studied by echocardiography in 68 patients (age, 74 +/- 7 years) with aortic annulus diameter < or =23 mm who were undergoing prosthesis implantation due to aortic isolated stenosis. Stented bioprostheses (Carpentier-Edwards Perimount [CEP]) were implanted in 36 subjects and stentless bioprostheses (18 Toronto SPV and 14 Shelhigh Super Stentless) were implanted in 32 subjects.


RESULTS
A progressive and similar decrease in left ventricular mass of 30% was observed in both stented and stentless bioprostheses at 12 months. A progressive increase in transprosthetic effective orifice area and a decrease in transprothetic pressure gradient were observed at 3, 6, and 12 months in the Toronto group, but these variables showed improvement only at 3 months in the CEP and Shelhigh groups. No mortality occurred during surgery or during the 1-year follow-up period.


CONCLUSIONS
Our results confirmed good feasibility of aortic stented and stentless bioprostheses implantation in the elderly population. A 30% decrease in left ventricular mass occurred in the early- and mid-term (12 months) periods after surgery with all 3 types of bioprostheses. Advantages consisting of a progressive increase in transprosthetic effective orifice area and a decrease of the transprosthetic pressure gradient were observed in the Toronto group in comparison to the CEP and Shelhigh groups. These observations may help surgeons in choosing bioprostheses.
Tsialtas
Dimitri
D
Cattedra di Cardiologia, Università degli Studi di Parma, Parma, Italy.
Bolognesi
Roberto
R
Beghi
Cesare
C
Albertini
Daniela
D
Bolognesi
Maria Giulia
MG
Manca
Carlo
C
Gherli
Tiziano
T
D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D020257:Ventricular Remodeling