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European Heart Journal Advance Access originally published online on August 1, 2007
European Heart Journal 2007 28(19):2369-2374; doi:10.1093/eurheartj/ehm327
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Stentless vs. stented aortic valve bioprostheses: a prospective randomized controlled trial

J. Dunning*, R.J. Graham, J. Thambyrajah, M.J. Stewart, S.W.H. Kendall and S. Hunter

Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, TS4 3BW, UK

Received 12 February 2007; revised 13 June 2007; accepted 6 July 2007; online publish-ahead-of-print 1 August 2007.

* Corresponding author. Tel: +44 7801548122; fax: +44 7801548122. E-mail address: joeldunning{at}doctors.org.uk

Aims: We sought to assess the haemodynamic profile of the Freedom stentless aortic valve compared with a stented bioprosthesis in a randomized controlled trial using echocardiography.

Methods and results: Sixty patients (mean age 73 years) undergoing bioprosthetic aortic valve replacement (AVR) were randomized to either Sorin Freedom stentless (n = 31) or Sorin More stented (n = 29) valves. The primary endpoints were left ventricular mass index (LVMI) reduction at 6 and 12-months. We also assessed post-operative effective orifice area index (EOAI), aortic gradient and operative time. There were no significant differences in baseline characteristics. The stentless valve was associated with a lower post-operative gradient [PG 17 (12) vs. 31 (13) mmHg, P < 0.0001] and greater EOAI [1.1 (0.3) vs. 0.8 (0.2) cm2/m2, P < 0.0001]. A highly significant reduction in LVMI occurred by 6 months in both groups, but LVMI was significantly lower in the stentless group [LVMI 119 (39) vs. 135 (30) g/m2, P = 0.05]. However, there was continued regression of left ventricular hypertrophy (LVH) in the stented but not in the stentless group, resulting in no significant difference in LVMI at 12 months [119 (36) vs. 126 (31) g/m2, P = 0.42].

Conclusion: The use of the Sorin Freedom stentless bioprosthesis for AVR results in lower PG and greater EOA when compared with a Sorin More stented valve. This is associated with earlier regression of LVH.

Key Words: Aortic valve replacement • Thoracic surgery • Stentless valve • Mass regression


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