Abstract
BackgroundTo compare the perioperative and long term survival after aortic valve replacement using stentless versus stented valves in a large cohort of patients grouped using propensity score matching.MethodsFrom 1991 to 2012, 4,563 patients underwent aortic valve replacement with stentless and stented valves at our institution. Propensity score matching identified 444 pairs using 13 independent variables: incidence of operation, smoking status, renal failure, hypertension, diabetes, peripheral vascular disease, cerebrovascular disease, chronic lung disease, ejection fraction, gender, age, valve status, and use of coronary artery bypass graft. Data were collected from our Society of Thoracic Surgeons database and the Social Security Death Index. Groups were compared using univariate and Kaplan-Meier analysis.ResultsThe two groups demonstrated no significant differences for the 13 matching variables and the majority of 30-day outcomes (p > 0.05). The stented valve group showed a higher incidence of postoperative bleeding (3.6% vs 1.1%, p = 0.015), but a lower incidence of stroke (0.9% vs. 2.9%, p = 0.028). One, five, and 10-year survival was 95.0, 80.7, and 52.8% for stented and 93.2, 80.5, and 51.3% for stentless valves. Overall survival did not differ significantly between the two groups (p = 0.641).ConclusionsStentless and stented valves had identical 30-day outcomes except for a higher postoperative incidence of bleeding and a lower incidence of stroke in the stented group. There was no significant difference in long term survival between valve types. Both valves may be used for aortic valve replacement with low morbidity and excellent long term survival.
Highlights
To compare the perioperative and long term survival after aortic valve replacement using stentless versus stented valves in a large cohort of patients grouped using propensity score matching
In the 1990’s the stentless aortic valve was introduced in an effort to more closely model the hemodynamics of the native valve, possibly improving valve
The choice of stentless or stented valve has been debated as to which most closely mimics the hemodynamics of the natural valve, a characteristic that potentially leads to improved clinical outcome
Summary
To compare the perioperative and long term survival after aortic valve replacement using stentless versus stented valves in a large cohort of patients grouped using propensity score matching. Aortic valve replacement (AVR) is the standard of care for patients with significant aortic valve pathology [1]. Symptomatic aortic valve disease necessitating replacement may consist of stenosis, regurgitation or a mixed pattern. The stented valve has for decades been the most frequently employed valve in the aortic position when choosing a bioprosthesis. Two studies have shown that stentless valves have improved survival rates and reduced incidence of adverse events [14, 15]. No large-scale studies directly comparing the clinical outcomes of these two valves are available in the literature. This study analyzes a single institution’s experience over the past two decades
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