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Updated: Jul 28, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Midterm survival of stented versus stentless valves: does concomitant coronary artery bypass grafting impact
D F Del Rizzo1, D Freed, A Abdoh
1University of Manitoba, Winnipeg, MB, Canada.
Insights
Stentless bioprosthetic valves show improved midterm survival after aortic valve replacement (AVR) compared to stented valves. This survival benefit is more pronounced in patients also undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Aortic valve replacement (AVR) is a critical procedure for managing aortic valve disease.
- The choice between stentless and stented bioprosthetic valves may influence long-term patient survival.
- Concomitant coronary artery bypass grafting (CABG) is frequently performed with AVR, potentially affecting outcomes.
Purpose of the Study:
- To compare survival rates between stentless and stented bioprosthetic valves in patients undergoing AVR.
- To evaluate the impact of concomitant CABG on survival in patients receiving different valve types.
- To identify factors influencing survival following AVR.
Main Methods:
- Retrospective analysis of survival data from 1798 patients undergoing AVR between 1991 and 1997.
- Comparison of survival probabilities using Kaplan-Meier curves and log-rank tests.
- Multivariable Cox proportional hazard models to adjust for confounding variables.
Main Results:
- Five-year survival was 84% for stentless valves versus 79% for stented valves (P=.004).
- In patients with concomitant CABG, survival was significantly better with stentless valves (82%) than stented valves (77%, P=.049).
- Valve type and patient age were significant predictors of survival in multivariable analysis.
Conclusions:
- Stentless bioprosthetic valves are associated with improved midterm survival following AVR compared to stented valves.
- The survival advantage of stentless valves appears greater in patients undergoing concomitant CABG.
- These findings support the use of stentless valves, particularly in patients requiring combined AVR and CABG procedures.
Abstract:
The purpose of this study was to examine the impact of concomitant coronary artery bypass grafting (CABG) and valve design on survival following aortic valve replacement (AVR) with stentless and stented bioprostheses. Survival data for 1798 patients undergoing AVR between 1991 and 1997 with either a stentless (Medtronic Freestyle = 700, Toronto SPV = 447; N = 1147) or stented (Hancock II = 224, Carpentier-Edwards SAV = 427; N = 651) valve were analyzed. Bivariable analyses using Kaplan-Meier survival curves and log-rank test were performed to compare survival probabilities by valve type. Multivariable stepwise Cox's proportional hazard models were used to control for potentially confounding variables. Concomitant CABG was performed in 41% of stentless and 46% of stented patients (P =.04). Survival probability at 5 years was 0.84 (95% CI = 0.81, 0.87) for stentless versus 0.79 (95% CI = 0.75, 0.83) for stented patients (P =.004). In the absence of concomitant CABG, survival was superior in stentless (0.84) over stented (0.80) patients, but these differences were not statistically significant (P =.053). In patients that underwent AVR with concomitant CABG, survival was significantly better in stentless patients (0.82) than in stented individuals (0.77, P =.049). The unadjusted hazard ratio for stented versus stentless was 1.44 (95% CI = 1.12, 1.86, P =.005). In the final Cox's proportional hazard model the variables that effected survival were valve type and age in decades. New York Heart Association class at the time of surgery had a marginal effect on survival. The data demonstrate improved midterm survival with stentless versus stented valves. Subgroup analysis suggests survival benefits of stentless valves may be greater in patients who undergo concomitant CABG surgery.
