1. Midterm Outcomes of Stented Versus Stentless Bioprosthetic Valves After Aortic Root Replacement
- Author
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Arman Kilic, Derek Serna-Gallegos, Danny Chu, James A. Brown, Ibrahim Sultan, Forozan Navid, Yancheng Dai, and Courtenay Dunn-Lewis
- Subjects
Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Regurgitation (circulation) ,Prosthesis Design ,Aortic aneurysm ,Aortic valve replacement ,medicine.artery ,medicine ,Humans ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Aorta ,Ejection fraction ,business.industry ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Propensity score matching ,Stents ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
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.
- Published
- 2022