Sustitución valvular aórtica con prótesis biológicas en pacientes con estenosis aórtica severa. ¿Válvulas soportadas o no soportadas?

Abstract

Introduction and objectivesIt is considered that a Stentless bioprosthesis reverses the left ventricular hypertrophy more than a Stented bioprosthesis in aortic valve replacement (AVR). There is no comparison in a non-Anglo-Saxon population.We aim to determine whether there are any statistically significant differences when analysing the survival, New York Heart Association (NYHA) functional status, and regression of left ventricular mass index (LVMI), as well as other variables. MethodsA retrospective analytical study was conducted on 120 patients matched by propensity score who, from April 2002 to March 2009, underwent scheduled isolated AVR due to severe aortic stenosis with bovine pericardial tissue valves (60 Stentless Freedom versus 60 Stented Mitroflow, Sorin Group). ResultsThe mean follow-up was 48.4±22 months. No significant differences were detected in NYHA functional class (mean 1.78±0.5, Stentless Vs 1.72±0.6 Stented, p=.616), or mean LVMI regression, which was 42.2g/m2 (25.3%) in Stented, and 36.3g/m2 22.6%) in Stentless (p=.467). Stentless valves had a lower transaortic mean gradient (14.4±6.8mmHg Stented, Vs 9.3± 3.2mmHg Stentless, P=.05), and a higher indexed effective orifice area (0.76±0.1cm2/m2 Stented Vs 0.83±0.1cm2/m2 Stentless, p=.04) within the first 24 months postoperative, becoming similar later. There was no difference in survival (p=.185). ConclusionsStented biological valves are as effective as Stentless bioprostheses. There were no statistically significant differences in survival, NYHA functional class, or LVMI regression at the mean follow up, even in patients with a small aortic annulus of 19–21mm.