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Biological aortic valve replacement: advantages and optimal indications of stentless compared to stented valve substitutes. A review

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Abstract

Controversy still surrounds the optimal biological valve substitute for aortic valve replacement. In light of the current literature, we review advantages and optimal indications of stentless compared to stented aortic bio-prostheses. Recent meta-analyses, prospective randomized controlled trials and retrospective studies comparing the most frequently used stentless and stented aortic bio-prostheses were analyzed. In the present review, the types and implantation techniques of the bio-prosthesis that are seldom taken into account by most studies and reviews were integrated in the interpretation of the relevant reports. For stentless aortic root bio-prostheses, full-root vs. sub-coronary implantation offered better early transvalvular gradients, effective orifice area and left ventricular mass regression as well as late freedom from structural valve deterioration in retrospective studies. Early mortality and morbidity did not differ between the stentless and stented aortic bio-prostheses. Early transvalvular gradients, effective orifice area and regression of left ventricular hypertrophy were significantly better for stentless, especially as full-root, compared to stented bio-prostheses. The long-term valve-related survival for stentless aortic root and Toronto SPV bio-prosthesis was as good as that for stented pericardial aortic bio-prostheses. For full-root configuration this survival advantage was statistically significant. There seems to be not one but different ideal biological valve substitutes for different subgroups of patients. In patients with small aortic root or exposed to prosthesis–patient mismatch full-root implantation of stentless bio-prostheses may better meet functional needs of individual patients. Longer follow-ups on newer generation of stented bio-prostheses are needed for comparison of their hemodynamic performance with stentless counterparts especially in full-root configuration.

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Acknowledgements

This work was supported by a Grant (N° 321120) of the Swiss Cardiovascular Foundation to RT.

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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Pitié Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), Institut de Cardiologie, Paris, France

    Reza Tavakoli, Pichoy Danial, Ahmed Hamid Oudjana, Pascal Leprince & Guillaume Lebreton

  2. Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    Reza Tavakoli & Max Gassmann

  3. Herzzentrum Hirslanden, Klinik St Anna, Lucerne, Switzerland

    Peiman Jamshidi

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  1. Reza Tavakoli
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Correspondence to Reza Tavakoli.

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Tavakoli, R., Danial, P., Oudjana, A.H. et al. Biological aortic valve replacement: advantages and optimal indications of stentless compared to stented valve substitutes. A review. Gen Thorac Cardiovasc Surg 66, 247–256 (2018). https://doi.org/10.1007/s11748-018-0884-3

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