Prosthesis-patient mismatch: hemodynamic comparison of stented and stentless aortic valves

Several centers have reported excellent clinical performance of stentless aortic xenografts. This study reports a hemodynamic comparison of the Medtronic Freestyle stentless and Mosaic stented valves. The prosthetic hemodynamics at discharge and 1 year after insertion in 95 patients who underwent aortic valve replacement with the Freestyle stentless bioprosthesis at Southern California Kaiser Permanente Medical Center were compared retrospectively with 115 unmatched individuals who received the Mosaic stented valve at the University of British Columbia. As assessed by echocardiography, there were no differences in the mean transvalvular gradient, effective orifice area (EOA), or EOA indexed to body surface area (EOAI) at discharge between the two groups. However, after 1 year, all corresponding Freestyle valve sizes had larger EOAs and lower gradients. Furthermore, fewer patients receiving Freestyle xenografts had prosthesis-patient mismatch (19% vs. 64%, P<.001) as defined by EOAI <0.85 cm2/m2. Although the Mosaic stented valve provides comparable immediate hemodynamic performance after implantation, there is significant improvement with the Freestyle bioprosthesis in terms of gradient, EOA, and prosthetic-patient mismatch at 1 year.