Is a stentless aortic valve superior to conventional bioprosthetic valves for aortic valve replacement?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether a stentless valve is superior to conventional stented valves when tissue aortic valve replacement is performed. Altogether more than 515 papers were found using the reported search, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that stentless valves allow a larger effective orifice area valve to be implanted with a lower mean and peak aortic gradient postoperatively. At six months several studies and a meta-analysis have shown superior left ventricular mass regression in the stentless valve groups. However, by 12 months the stented valve groups catch up in terms of mass regression and this significance disappears. So the 'eminent speaker from the floor', was right with his statement, that there have been no definitively proven benefits for stentless valves.
Department of Cardio-thoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK. adonkal@doctors.org.uk
Antonios
A
Kallikourdis
Samuel
S
Jacob
D001021:Aortic Valve / Q000601:surgery*; D019985:Benchmarking; D001705:Bioprosthesis; D019317:Evidence-Based Medicine; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome