Influence of stentless versus stented valves on ventricular remodeling assessed at 6 months by magnetic resonance imaging and long-term follow-up.
To compare the effect of stented versus stentless bioprostheses on left ventricular remodeling and assess their impact on long-term survival.



From January 2002 to December 2009, 62 severe aortic stenosis patients without coronary artery disease were randomized for bioprosthetic aortic valve replacement. After randomization, a cross-over was possible based on intraoperative data. Ventricular remodeling was studied by cardiovascular magnetic resonance imaging six months after surgery. Long-term survival was assessed by telephone survey.



Thirty-five patients received a porcine Mosaïc®Medtronic bioprosthesis (Stented Group; Medtronic, Minneapolis, MN, USA) inserted using the usual supra-annular technique and 27 received a porcine Freestyle®Medtronic bioprosthesis (Stentless Group) inserted in the subcoronary position. Mean age was 75±3 and 73±4 years in the stentless and stented group, respectively. Nine patients who should have been implanted with a stentless bioprosthesis received a stented bioprosthesis for anatomical reasons. At 6 months, the left ventricular mass (LVM) decreased significantly in both groups (Stentless Group: 214.6±56.1g and 156.3±23g and Stented Group: 237±75.7g and 181±53.3g, respectively after surgery and at 6 months), this decrease was significantly greater in the stentless group (p=0.026). Reserve and coronary flow were increased in both groups at 6 months. Mean follow-up duration was 6.6±3.0 years and 7.2±4.0 years in the stentless and stented group, respectively. The 5-year actuarial survival was 87.5±11.7% and 82.5±17.1% for the stentless and stented group, respectively (p=0.81).



Porcine stentless prosthesis results in a better LVM regression than a stented valve at 6 months without changing the long-term survival.
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC CNRS UMR 6214, INSERM U1083, University Hospital, Angers, France. Electronic address: olfouquet@chu-angers.fr.
Olivier
O
Fouquet
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC CNRS UMR 6214, INSERM U1083, University Hospital, Angers, France.
Christophe
C
Baufreton
Department of Cardiology, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Aude
A
Tassin
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC CNRS UMR 6214, INSERM U1083, University Hospital, Angers, France.
Frédéric
F
Pinaud
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Jean-Patrice
JP
Binuani
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC CNRS UMR 6214, INSERM U1083, University Hospital, Angers, France.
Simon
S
DangVan
Department of Cardiology, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Fabrice
F
Prunier
Department of Cardiology, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Frédéric
F
Rouleau
Institut MITOVASC EA 3860, University Hospital, Angers, France; Department of Radiology, University Hospital, Angers, France.
Serge
S
Willoteaux
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Jean-Louis
JL
De Brux
Department of Cardiology, University Hospital, Angers, France; Institut MITOVASC EA 3860, University Hospital, Angers, France.
Alain
A
Furber
D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D057194:Intention to Treat Analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D015607:Stents / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013552:Swine; D016896:Treatment Outcome; D020257:Ventricular Remodeling
Aortic valve replacement; Computed tomography; Coronary artery imaging; Myocardial remodeling; Prosthesis