Stentless vs Stented Aortic Valve Bioprostheses in the Small Aortic Root

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• 作者：Laurens W. Wollersheim ; MD^* ; ^{l.w.wollersheim@amc.nl} ; Wilson W. Li ; MD^* ; Abdullah Kaya ; MD ; PhD^* ; Berto J. Bouma ; MD ; PhD^&dagger ; ; Antoine H. Driessen ; MD^* ; Wim J. van Boven ; MD ; PhD^* ; Jan van der Meulen ; MD^* ; Bas A. de Mol ; MD ; PhD^*
• 关键词：Aortic valve replacement ; Small aortic root ; Aortic valve bioprosthesis ; Stentless bioprosthesis
• 刊名：Seminars in Thoracic and Cardiovascular Surgery
• 出版年：2016
• 出版时间：Summer 2016
• 年：2016
• 卷：28
• 期：2
• 页码：390-397
• 全文大小：758 K
• 卷排序：28

文摘

In patients with a small aortic root undergoing aortic valve replacement (AVR), the Freedom SOLO bioprosthesis may be the ideal prosthesis because of its stentless design and supra-annular implantation. This study investigated if the stentless Freedom SOLO has an advantage when compared with a stented bioprosthesis in patients with a small aortic root. From April 2005-July 2014, 269 consecutive patients underwent AVR with either a Freedom SOLO (n = 76) or Mitroflow (n = 193) bioprosthesis size 19 mm or 21 mm, respectively. This retrospective comparison study presents clinical and echocardiographic follow-up data. In results, operative outcome and survival were similar. At 7 years, cumulative incidence of aortic valve reoperation and structural valve deterioration favor the Freedom SOLO (0% vs 7.1%, P = 0.03 and 0% vs 4.5%, P = 0.08, respectively). Additionally, the postoperative peak and mean valvular gradients favor the Freedom SOLO (21 ± 9 mm Hg vs 32 ± 12 mm Hg and 12 ± 5 mm Hg vs 19 ± 8 mm Hg, both P = <0.001, respectively). During mid-term follow-up this hemodynamic advantage continued in favor of the Freedom SOLO. Also prosthesis-patient mismatch occurred less frequently in the Freedom SOLO (28% vs 52%, P = 0.001). There were no differences in prosthetic valve endocarditis, thromboembolic, or bleeding events. In conclusion, the stentless Freedom SOLO has several significant advantages for AVR in patients with a small aortic root in comparison with a stented Mitroflow bioprosthesis. The Freedom SOLO shows superior hemodynamic performance with significantly lower valvular gradients that remained stable during mid-term follow-up. Additionally, significantly fewer prosthesis-patient mismatch occurred and the Freedom SOLO showed superior durability.