title: Clinical and hemodynamic outcomes after aortic valve replacement with stented and stentless pericardial xenografts: a propensity-matched analysis.
abstract: OBJECTIVE
  Pericardial aortic xenografts have demonstrated excellent durability, and also freedom from tissue failure and from endocarditis. The aim of this single-center propensity-matched study was to compare the clinical and hemodynamic results of aortic valve replacement (AVR) with that for stented and stentless pericardial bioprostheses.
  
  
  METHODS
  A total of 111 consecutive AVRs with the Perimount Magna stented valve, performed between December 2002 and December 2007, and 150 consecutive AVRs with the Pericarbon Freedom stentless bioprosthesis, performed between July 1999 and December 2007, was reviewed. Based on a propensity-score analysis, 81 matched pairs were created. The mean age of the 162 patients was 74 +/- 7 years. In total, 31 (38%) and 39 (48%) associated procedures were performed in the stented and stentless groups, respectively (p = 0.20). The mean follow up for stented-valve patients was 20 +/- 9 months (range: 6-35 months), and for stentless-valve patients was 36 +/- 21 months (range: 6-83 months) (p < 0.05).
  
  
  RESULTS
  The operative mortality was 4.9% (n = 4) and 6.2% (n = 5) (p = 0.77) in the stented- and stentless-valve groups, respectively. The cumulative actuarial freedom from structural valve deterioration, non-structural dysfunction, reoperation, prosthetic valve endocarditis, hemorrhage and thromboembolic events after 24 months were 98.4 +/- 1.5% and 96.4 +/- 2.6% (p = 0.12) for the stented- and stentless-valve groups, respectively; the actuarial survival rates after 24 months were 82.6 +/- 5.2% and 83.8 +/- 4.3% (p = 0.82), respectively, while freedom from valve-related death was 98.4 +/- 1.5% and 97.2 +/- 1.9% (p = 0.56), respectively. No statistically significant differences were identified between the peak and mean transaortic gradients.
  
  
  CONCLUSIONS
  Both, the stented and stentless pericardial aortic xenografts provided good clinical and hemodynamic results. However, the study results failed to demonstrate any difference regarding early outcomes between the two groups.
authors.affiliation: Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy. adonofrio@hotmail.it
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: Cresce
authors.forename: Irene
authors.initials: I
authors.lastname: Bolgan
authors.forename: Paolo
authors.initials: P
authors.lastname: Magagna
authors.forename: Caterina
authors.initials: C
authors.lastname: Piccin
authors.forename: Stefano
authors.initials: S
authors.lastname: Auriemma
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fabbri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D016009:Chi-Square Distribution; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016017:Odds Ratio; D010496:Pericardium / Q000637:transplantation*; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome