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Midterm Outcomes of Stented Versus Stentless Bioprosthetic Valves After Aortic Root Replacement

  • James A. Brown
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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  • Derek Serna-Gallegos
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • Arman Kilic
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • Yancheng Dai
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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  • Danny Chu
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • Forozan Navid
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • Courtenay Dunn-Lewis
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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  • Ibrahim Sultan
    Correspondence
    Address reprint requests to: Ibrahim Sultan, MD, Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, UPMC Center for Thoracic Aortic Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite 715, Pittsburgh, PA 15232.
    Affiliations
    Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
    Search for articles by this author
Published:September 11, 2021DOI:https://doi.org/10.1053/j.semtcvs.2021.09.003
      To determine the impact of aortic root replacement (ARR) with a stentless bioprosthetic valve on midterm outcomes compared to a stented bioprosthetic valve-graft conduit. This was an observational study of aortic root operations from 2010 to 2018. All patients with a complete ARR for nonendocarditis reasons were included, while patients undergoing valve-sparing root replacements or primary aortic valve replacement or repair were excluded. Of the patients with a complete ARR, bioprosthetic valve implants were included, while mechanical valve implants were excluded. Patients were dichotomized into the stented ARR group and the stentless ARR group. A total of 1:1 nearest neighbor propensity matching was employed to assess the association of stentless valves with short-term and midterm outcomes. A total of 455 patients underwent a complete ARR with a bioprosthetic valve implant for nonendocarditis reasons, of which 212 (46.6%) received a stented valve, while 243 (53.4%) received a stentless valve. After matching, postoperative outcomes were similar across each group (P > 0.05), including operative mortality and adverse neurologic events. Median follow-up for the entire cohort was 4.41 years (95% CI: 4.01, 4.95). At 1 year follow-up, aortic regurgitation ≥ 2+ and ejection fraction were similar across each group (P > 0.05); however, the stentless valve group had lower aortic valve velocity and transvalvular pressure gradient. Finally, reoperations and survival were similar for each group over the study's follow-up (P > 0.05). Stentless valves may provide hemodynamic benefits after ARR; however, the clinical impact of those benefits for survival and reoperation may not yet be evident in the midterm.

      Graphical abstract

      Keywords

      Abbreviations:

      AVR (aortic valve replacement), ARR (aortic root replacement), CABG (coronary artery bypass graft), EOA (effective orifice area), LV (left ventricular), UPMC (University of Pittsburgh Medical Center), STS (Society of Thoracic Surgeons)
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      Linked Article

      • Commentary: Rooting for the Best Root Prosthesis
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
        • Preview
          Brown and colleagues compared the outcomes of stented versus stentless bioprosthetic root replacement in 455 patients.1 Mean patient age was 70 years and the study excluded mechanical prostheses. Medtronic Freestyle porcine bioprosthesis (Medtronic, Minneapolis, MN) was used for all stentless valve implants.
        • Full-Text
        • PDF
      • Commentary: Quizzes, Midterms, and Finals: Considerations in Aortic Root Replacement
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 4
        • Preview
          In this issue of Seminars in Thoracic and Cardiovascular Surgery, the aortic surgery group from the University of Pittsburgh presents comparative results of aortic root replacement (ARR) using either stentless or stented bioprostheses.1 Briefly summarized, the authors found that larger stentless aortic root prostheses were able to be implanted, and that across all sizes implanted (not just with smaller sizes), statistically significant superior prosthetic valve physiology (as assessed non-invasively) was observed.
        • Full-Text
        • PDF