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Related Experiment Videos

Stentless or stented aortic valve implants in elderly patients?

G Van Nooten1, F Caes, K François

  • 1Cardiac Surgery Department, University Hospital Gent, Ghent, Belgium. guido.vannooten@rug.ac.be

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 17, 1999
PubMed
Summary

Stentless aortic valve replacement offers higher survival rates and improved cardiac function in elderly patients compared to stented procedures. Despite a more demanding implantation, stentless valves provide better outcomes for specific patient groups.

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Area of Science:

  • Cardiovascular Surgery
  • Bioprosthetic Valves
  • Geriatric Cardiology

Background:

  • Elderly patients undergoing aortic valve replacement present unique challenges.
  • Comparing stentless and stented bioprostheses is crucial for optimizing outcomes in this population.

Purpose of the Study:

  • To evaluate differences in indications and mid-term results between stentless and stented aortic valve procedures in elderly patients.
  • To assess the efficacy and safety of stentless versus stented bioprostheses over a 5-year follow-up period.

Main Methods:

  • A consecutive series of 154 elderly patients (mean age 74.8 years) underwent aortic valve replacement with either stentless (n=103) or stented (n=51) bioprostheses.
  • Follow-up ranged from 6 to 66 months with 97% completeness, utilizing Kaplan-Meier survival analysis and echocardiography.

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Main Results:

  • Stentless procedures had a longer aortic clamp time (70 vs. 57 min) but demonstrated statistically higher survival rates (log rank: P = 0.03).
  • Stentless valves showed favorable transvalvular gradients in smaller valves, improved left ventricular function, and reduced LVEDD at 1 year.
  • Cusp calcifications appeared earlier in the stented group, with similar early dysfunction rates between groups.

Conclusions:

  • Despite technical challenges and contraindications, stentless aortic valve prostheses offer significant benefits for elderly patients, particularly those with smaller aortic dimensions.
  • The improved hemodynamics and ventricular remodeling associated with stentless valves contribute to better long-term outcomes in selected elderly patients.