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Updated: Jul 13, 2026
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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Stentless vs. stented aortic valve bioprostheses: a prospective randomized controlled trial
J Dunning1, R J Graham, J Thambyrajah
1Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, TS4 3BW, UK. joeldunning@doctors.org.uk
European Heart Journal
|August 3, 2007
Summary
The Freedom stentless aortic valve shows better early hemodynamics than stented valves, with lower gradients and larger effective orifice area, but similar left ventricular mass index at 12 months.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Echocardiography
Background:
- Bioprosthetic aortic valve replacement (AVR) is a common procedure.
- Stentless bioprosthetic valves aim to improve hemodynamic performance compared to stented valves.
- Left ventricular remodeling is a key indicator of prosthetic valve function.
Purpose of the Study:
- To compare the hemodynamic profile of the Freedom stentless aortic valve with a stented bioprosthesis.
- To evaluate left ventricular mass index (LVMI) reduction and effective orifice area index (EOAI) post-AVR.
- To assess aortic gradients and operative times in a randomized controlled trial.
Main Methods:
- Randomized controlled trial involving 60 patients undergoing AVR.
- Patients were randomized to receive either the Sorin Freedom stentless valve (n=31) or the Sorin More stented valve (n=29).
- Echocardiography was used to assess primary endpoints: LVMI reduction at 6 and 12 months, and secondary endpoints: post-operative EOAI, aortic gradient, and operative time.
Main Results:
- The stentless valve group demonstrated a significantly lower post-operative aortic gradient (17 vs. 31 mmHg) and a greater EOAI (1.1 vs. 0.8 cm²/m²).
- Both groups showed significant LVMI reduction by 6 months, with a trend towards lower LVMI in the stentless group (119 vs. 135 g/m²).
- While LVH regression continued in the stented group, it plateaued in the stentless group, resulting in no significant difference in LVMI at 12 months.
Conclusions:
- The Freedom stentless bioprosthesis offers superior early hemodynamic advantages, including lower gradients and larger effective orifice area, compared to the Sorin More stented valve.
- These hemodynamic benefits are associated with earlier regression of left ventricular hypertrophy.
- Long-term differences in LVMI between stentless and stented valves may diminish due to continued remodeling in stented prostheses.
