HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thierry Bové Yves Van Belleghem Katrien François Hans Van Overbeke Guido Van Nooten Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bové, T. Articles by Van Nooten, G. Search for Related Content PubMed PubMed Citation Articles by Bové, T. Articles by Van Nooten, G. Related Collections Valve disease

Eur J Cardiothorac Surg 2006;30:706-713
© 2006 Elsevier Science NL

Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcome

Department of Cardiac Surgery, University Hospital of Ghent, 5K12, De Pintelaan 185, 9000 Ghent, Belgium

Received 28 April 2006; received in revised form 3 July 2006; accepted 17 July 2006.

^_* Corresponding author. Tel.: +32 9 2403925; fax: +32 9 2403882. (Email: Thierry.bove{at}Ugent.be).

Objective: To report on the midterm results of aortic valve replacement (AVR) with stented and stentless bioprosthesis in an elderly population by analyzing the factors affecting survival and hemodynamical performance. Methods: In a retrospective study, 145 patients with a Toronto stentless prosthesis are compared with 110 patients with a stented Carpentier-Edwards valve. The 5- to 10-year clinical outcome, transprosthetic gradients, and early and late left ventricular mass (LVM) regression are analyzed in view of specific prosthesis- and patient-related factors. Results: Actuarial survival at 5 years is 82% after stentless AVR versus 68% after stented AVR (p < 0.001) in elderly patients. However, there was no difference in survival at 8 years, being 55.9% and 59.5%, respectively. Univariate analysis revealed that advanced age at the time of operation, NYHA class IV, use of a stented xenograft, presence of patient-prosthesis mismatch (PPM) (IEOA 0.85 cm²/m²), and severe preoperative left ventricular (LV) hypertrophy (LVMI > 180 g/m²) affected survival adversely. But multivariate analysis determined only age, NYHA class IV and excessive LV hypertrophy as independent predictors of late mortality. Stented and stentless xenografts were equally effective in terms of transprosthetic gradients and LVMI regression. The use of a stentless valve significantly reduced the occurrence of PPM (18% vs 41%, p < 0.01). Early LVMI regression at 1 year was optimized by the avoidance of PPM, indicated by a higher absolute (43.7 ± 28.3 g/m² vs 58.6 ± 33.8 g/m², p = 0.003) and relative (25.0 ± 12.7% vs 31.4 ± 14.9%, p = 0.004) mass regression. However, late LV remodeling was predominantly affected by systemic hypertension and severe preoperative LV hypertrophy, resulting in the incomplete LVMI resolution in 61.3% and 66.7% of these patients, respectively. Conclusion: In elderly patients, aortic valve replacement appears to be equally effective with a stentless or stented bioprosthesis. Midterm clinical outcome is mainly determined by patient-related factors such as age, advanced NYHA class, and severity of preoperative LV hypertrophy. Regarding post-AVR left ventricular remodeling, patient-prosthesis mismatch influences the early phase, whereas arterial hypertension affects the late regression more. However, the left ventricular remodeling is continuously compromised by the preoperative presence of excessive hypertrophy, despite the efficacy of the aortic valve replacement.

Key Words: Stentless prosthesis • Aortic valve replacement • Left ventricular mass regression

This article has been cited by other articles:

				S. Urso, R. Sadaba, and G. Aldamiz-Echevarria Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement? Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 510 - 518. [Abstract] [Full Text] [PDF]

				S. Nozohoor, J. Nilsson, C. Luhrs, A. Roijer, and J. Sjogren Influence of Prosthesis-Patient Mismatch on Diastolic Heart Failure After Aortic Valve Replacement Ann. Thorac. Surg., April 1, 2008; 85(4): 1310 - 1317. [Abstract] [Full Text] [PDF]

				A. Kallikourdis and S. Jacob Is a stentless aortic valve superior to conventional bioprosthetic valves for aortic valve replacement? Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 665 - 672. [Abstract] [Full Text] [PDF]

				M. J. Antunes Editorial comment: Aortic stenosis in the elderly: rethinking strategies Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 713 - 715. [Full Text] [PDF]