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J Thorac Cardiovasc Surg 1999;117:431-438
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

A NOVEL COMPARISON OF STENTLESS VERSUS STENTED VALVES IN THE SMALL AORTIC ROOT

From the Division of Cardiovascular Surgery, Sunnybrook Health Science Centre; University of Toronto, Toronto, Ontario, Canada.

Supported by the Heart and Stroke Foundation of Canada (grant NA-3026). V.R., G.C., and M.A.B. are Research Fellows of the Heart and Stroke Foundation of Canada. G.T.C. and S.E.F. are Research Scholars of the Heart and Stroke Foundation of Ontario.

Read at the Twenty-fourth Annual Meeting of The Western Thoracic Surgical Association, Whistler, British Columbia, June 24-27, 1998.

Received for publication July 15, 1998. Revisions requested Aug 20, 1998. Revisions received Sept 18, 1998. Accepted for publication Nov 12, 1998. Address for reprints: George T. Christakis, MD, Sunnybrook Health Science Centre, 2075 Bayview Ave, Suite H-406, Toronto, Ontario, Canada M4N 3M5.

Background: Previous studies have compared prosthetic valves on the basis of industry-labeled valve sizes. Unfortunately, the relationship between the labeled size and the true measured external or internal diameter differs between valve manufacturers. Therefore hemodynamic comparisons between prosthetic valves are inaccurate if based solely on industry-labeled valve sizes.
Methods: We have previously demonstrated that the internal diameter of a 21-mm Carpentier-Edwards pericardial stented valve is similar to that of a 25-mm Toronto stentless porcine valve. Therefore we chose to compare postoperative hemodynamics in patients who received 19-, 21-, or 23-mm Carpentier-Edwards pericardial stented valves (inner diameter 18-22 mm, n = 69) with those in patients who received 23- or 25-mm stentless porcine valves (internal diameter 19-21 mm, n = 41).
Results: Patients in the Carpentier-Edwards group were more likely to be elderly and more likely to require concomitant revascularization. Operative mortality was lower in the stentless porcine valve group (0% vs 9%, P = .06). Hospital stay and ventilation requirements were shorter in the stentless porcine valve group. Postoperative hemodynamics were similar in the two groups.
Conclusions: These data provide evidence that stentless and stented valves have similar hemodynamic profiles in the small aortic root when matched on true measured internal diameters. The clinical benefit of the stentless porcine valve may be due to patient selection or the lack of a rigid stent in the small aortic root, but it is not due to hemodynamic superiority over stented aortic valves of similar sizes.

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