title: Stentless Versus Stented Bioprosthetic Aortic Valves: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2008.
abstract: OBJECTIVE
  : The purpose of this consensus conference was to determine whether stentless bioprosthetic valves improve clinical and resource outcomes compared with stented valves in patients undergoing aortic valve replacement, and to outline evidence-based recommendations for the use of stentless and stented bioprosthetic valves in adult aortic valve replacement.
  
  
  METHODS
  : Before the consensus conference, the best available evidence was reviewed in that systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. At the consensus conference, evidence-based statements were created, and consensus processes were used to determine the ensuing recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of recommendation.
  
  
  CONCLUSIONS
  : Seventeen randomized studies published in 23 articles involving 1317 patients, and 14 nonrandomized trial published in 18 articles involving 2485 patients were included in the meta-analysis and consensus conference. All randomized trials inserted the stentless bioprosthetic valves in the subcoronary configuration. The consensus panel agreed upon the following statements and recommendations in patients undergoing aortic valve replacement:Because there were no randomized control trial comparing subcoronary stentless prosthetic valve and root replacement, the following recommendations are derived from expert opinion:
authors.affiliation: From the *Department of Cardiothoracic Surgery, Imperial College, Royal Brompton Hospital, London, UK; †Department of Anesthesia and Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR), London Health Sciences Centre, The University of Western Ontario, London, ON, Canada; ‡St. Mary's Hospital, London, UK; §Division of Thoracic and Cardiovascular Surgery, The Lankenau Hospital, Wynnewood, PA USA; ¶St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; ∥Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY USA; **Golden Jubilee National Hospital, Clydebank, UK; ††Department of Surgery, Siena University School of Medicine, Siena, Italy; and ‡‡High Impact Technology Evaluation Centre, London Health Sciences Centre, London, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Pepper
authors.forename: Davy
authors.initials: D
authors.lastname: Cheng
authors.forename: Rex
authors.initials: R
authors.lastname: Stanbridge
authors.forename: Francis D
authors.initials: FD
authors.lastname: Ferdinand
authors.forename: W R Eric
authors.initials: WR
authors.lastname: Jamieson
authors.forename: Paul
authors.initials: P
authors.lastname: Stelzer
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Berg
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.forename: Janet
authors.initials: J
authors.lastname: Martin