Back to Browse Journals » Vascular Health and Risk Management » Volume 7

Stentless aortic valve replacement: an update

Authors Kobayashi J

Published 2 June 2011 Volume 2011:7 Pages 345—351


Review by Single-blind

Peer reviewer comments 2

Junjiro Kobayashi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan

Abstract: Although porcine aortic valves or pericardial tissue mounted on a stent have made implantation techniques easier, these valves sacrifice orifice area and increase stress at the attachment of the stent, which causes primary tissue failure. Optimizing hemodynamics to prevent patient–prosthetic mismatch and improve durability, stentless bioprostheses use was revived in the early 1990s. The purpose of this review is to provide a current overview of stentless valves in the aortic position. Retrospective and prospective randomized controlled studies showed similar operative mortality and morbidity in stented and stentless aortic valve replacement (AVR), though stentless AVR required longer cross-clamp and cardiopulmonary bypass time. Several cohort studies showed improved survival after stentless AVR, probably due to better hemodynamic performance and earlier left ventricular (LV) mass regression compared with stented AVR. However, there was a bias of operation age and nonrandomization. A randomized trial supported an improved 8-year survival of patients with the Freestyle or Toronto valves compared with Carpentier–Edwards porcine valves. On the contrary, another randomized study did not show improved clinical outcomes up to 12 years. Freedom from reoperation at 12 years in Toronto stentless porcine valves ranged from 69% to 75%, which is much lower than for Carpentier–Edwards Perimount valves. Cusp tear with consequent aortic regurgitation was the most common cause of structural valve deterioration. Cryolife O'Brien valves also have shorter durability compared with stent valves. Actuarial freedom from reoperation was 44% at 10 years. Early prosthetic valve failure was also reported in patients who underwent root replacement with Shelhigh stentless composite grafts. There was no level I or IIa evidence of more effective orifice area, mean pressure gradient, LV mass regression, surgical risk, durability, and late outcomes in stentless bioprostheses. There is no general recommendation to prefer stentless bioprostheses in all patients. For new-generation pericardial stentless valves, follow-up over 15 years is necessary to compare the excellent results of stented valves such as the Carpentier–Edwards Perimount and Hancock II valves.
Keywords: cardiopulmonary bypass, valves, heart disease, surgery, follow-up studies

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Readers of this article also read:

Validation of four automatic devices for self-measurement of blood pressure according to the international protocol of the European Society of Hypertension

Topouchian J, Agnoletti D, Blacher J, Youssef A, Ibanez I, Khabouth J, Khawaja S, Beaino L, Asmar R

Vascular Health and Risk Management 2011, 7:709-717

Published Date: 30 November 2011

Lipid-lowering therapy: who can benefit

Lewis SJ

Vascular Health and Risk Management 2011, 7:525-534

Published Date: 24 August 2011

Renal artery stenosis in kidney transplants: assessment of the risk factors

Etemadi J, Rahbar K, Haghighi AN, Bagheri N, Falaknazi K, Ardalan MR, Ghabili K, Shoja MM

Vascular Health and Risk Management 2011, 7:503-507

Published Date: 10 August 2011

Vasodilatory effects of cinnamaldehyde and its mechanism of action in the rat aorta

Xue Y-L, Shi H-X, Murad F, Bian K

Vascular Health and Risk Management 2011, 7:273-280

Published Date: 28 April 2011

The pathology and treatment of cardiac arrhythmias: focus on atrial fibrillation

Schmidt C, Kisselbach J, Schweizer PA, Katus HA, Thomas D

Vascular Health and Risk Management 2011, 7:193-202

Published Date: 31 March 2011

Treatment options for hypertension in high-risk patients

Wei-Chuan Tsai

Vascular Health and Risk Management 2011, 7:137-141

Published Date: 9 March 2011

Skeletonized coronary arteries: pathophysiological and clinical aspects of vascular calcification

Carlos V Serrano Jr, Marcelo Oranges, Vitor Brunaldi, et al

Vascular Health and Risk Management 2011, 7:143-151

Published Date: 9 March 2011

The value of blood D-dimer test in the diagnosis of walk-in patients with venous thromboembolism

Shozo Yasuoka, Shunichiro Kubota

Vascular Health and Risk Management 2011, 7:125-127

Published Date: 1 March 2011

Endothelial function in a cardiovascular risk population with borderline ankle–brachial index

Kari Syvänen, Päivi Korhonen, Auli Partanen, et al

Vascular Health and Risk Management 2011, 7:97-101

Published Date: 23 February 2011

Antiplatelet combinations for prevention of atherothrombotic events

Mario Bollati, Fiorenzo Gaita, Matteo Anselmino

Vascular Health and Risk Management 2011, 7:23-30

Published Date: 12 January 2011