Retrospective clinical analysis of stented vs. stentless porcine aortic bioprostheses

Objective: The study was designed to compare: hemodynamic performance, stru ctural failure and survival of patients undergoing aortic valve replacement (AVR) with a composite aortic stented or stentless porcine bioprosthesis. Methods: From January 1990 to June 1999, the clinical data of 725 patients undergoing AVR with stented porcine aortic bioprosthesis were reviewed. We defined two groups of patients with similar clinical characteristics: 202 p atients receiving aortic stented and 205 patients stentless valves. The two patients groups were similar in age, sex, valve lesion, valve size, preope rative New York Heart Association (NYNA) class status and follow-up. Result s: The number of patients available for follow-up, excluding hospital and l ate mortality, reoperations and patients lost to follow-up, was 157 for the stented and 175 for the stentless group. There was a higher incidence of r heumatic heart disease in the stented (59%) vs. stentless group (44%), (P = 0.003). Fewer patients had prior aortic bioprosthetic dysfunction in the s tented (7.6%) compared to the stentless group (25%) (P < 0.001). The mean i ntensive care unit stay, hospital mortality and late mortality were similar (P, NS). The total complication rate was higher in the stented (12%) than the stentless (3.4%)(P = 0.005). Valve related death was higher in the sten ted (2.5%) than the stentless (0%) (P = 0.049). Postoperatively, the aortic effective orifice area (AEOA) was larger (P < 0.001) and the transvalvular peak and mean gradients were lower in the stentless group (P < 0.001). The leaflet tissue degeneration analysis was 8.0% in patients at risk for sten ted and 0.6% for stentless (P = 0.001). Actuarial analysis disclosed no sta tistical difference in patient survival between groups (P = 0.18). Reoperat ions were less frequent in the stentless group (P = 0.010). Conclusions: He modynamic benefits in the stentless group were evident and expressed by lar ger AEOA, lower gradients, better left ventricular remodeling with signific ant decrease of the left ventricular mass. Lower complication rates, lower reoperation rates, less leaflet tissue degeneration, and lower valve relate d mortality rates were seen in the stentless group. A controlled clinical c omparison trial with longer follow-up will be required to confirm these cli nical and hemodynamic benefits. (C) 2000 Elsevier Science B.V. All rights r eserved.