Stented vs. stentless in aortic stenosis: a systematic review and meta-analysis

Area of Science:

• Cardiovascular Surgery
• Biomaterials in Medicine
• Medical Devices

Background:

• Symptomatic aortic stenosis (AS) necessitates surgical intervention, commonly aortic valve replacement (AVR).
• Stented and stentless prostheses are the primary options for AVR.
• Stentless valves are theorized to offer hemodynamic advantages, but clinical evidence requires synthesis.

Purpose of the Study:

• To systematically review and meta-analyze the clinical effectiveness and safety of stented versus stentless aortic valve prostheses.
• To compare mortality rates, postoperative complications, and hemodynamic outcomes between the two valve types.

Main Methods:

• Systematic literature search adhering to PRISMA guidelines across major databases (PubMed, Cochrane, Scopus, Web of Science).
• Inclusion of randomized and non-randomized studies evaluating stented vs. stentless AVR.
• Meta-analysis using random-effects models to assess outcomes including mortality, stroke, pacemaker implantation, and hemodynamic parameters.

Main Results:

• Analysis of 20 studies with 3,940 participants revealed no significant differences in early or overall mortality rates.
• Postoperative complication rates were comparable, with the exception of a significantly higher incidence of pacemaker implantation in the stentless valve group (OR=1.82).
• Hemodynamic outcomes, including aortic valve gradient and left ventricular mass, showed no significant differences between stented and stentless valves.

Conclusions:

• Stented and stentless aortic valve replacements demonstrate comparable efficacy regarding mortality and most postoperative complications.
• A higher rate of pacemaker implantation is associated with stentless aortic valves.
• The choice between stented and stentless valves should consider the increased risk of pacemaker implantation with stentless options.