Stented versus Stentless Bioprostheses in Aortic Valve Stenosis: Effect on Left Ventricular Remodelling


  • Dimitri Tsialtas
  • Roberto Bolognesi
  • Cesare Beghi
  • Daniela Albertini
  • Maria Giulia Bolognesi
  • Carlo Manca
  • Tiziano Gherli



Background. Whether the use of stentless aortic bioprostheses improves hemodynamics more than stented bioprostheses in the small aortic root is still a matter of debate.

Methods. Early- and mid-term effects were compared between 2 different types of stentless bioprotheses and 1 type of stented bioprosthesis for left ventricular remodelling. The effects of the bioprotheses were studied by echocardiography in 68 patients (age, 74 ± 7 years) with aortic annulus diameter 23 mm who were undergoing prosthesis implantation due to aortic isolated stenosis. Stented bioprostheses (Carpentier-Edwards Perimount [CEP]) were implanted in 36 subjects and stentless bioprostheses (18 Toronto SPV and 14 Shelhigh Super Stentless) were implanted in 32 subjects.

Results. A progressive and similar decrease in left ventricular mass of 30% was observed in both stented and stentless bioprostheses at 12 months. A progressive increase in transprosthetic effective orifice area and a decrease in transprothetic pressure gradient were observed at 3, 6, and 12 months in the Toronto group, but these variables showed improvement only at 3 months in the CEP and Shelhigh groups. No mortality occurred during surgery or during the 1-year follow-up period.

Conclusions. Our results confirmed good feasibility of aortic stented and stentless bioprostheses implantation in the elderly population. A 30% decrease in left ventricular mass occurred in the early- and mid-term (12 months) periods after surgery with all 3 types of bioprostheses. Advantages consisting of a progressive increase in transprosthetic effective orifice area and a decrease of the transprosthetic pressure gradient were observed in the Toronto group in comparison to the CEP and Shelhigh groups. These observations may help surgeons in choosing bioprostheses.


Arom KV, Nicoloff DM, Kersten TE, et al. 1987. St. Jude Medical prostheses: valve related deaths and complications. Ann Thorac Surg 43:591-8.nBack DS. 2000. Echocardiographic assessment of stentless aortic bioprosthetic valves. J Am Soc Echocardiogr 13:941-8.nBlack MM, Cochrane T, Lawford PV, Reul H, Yoganathan A. 1976. Design and flow characteristics. In: Bodnar E, Frater R, eds. Replacement Cardiac Valves. New York, NY: McGraw-Hill; 1-20.nChristakis GT, Joyner CD, Morgan CD, et al. 1996. Left ventricular mass regression early after aortic valve replacement. Ann Thorac Surg 62:1084-9.nCohen G, Christakis GT, Joyner CD, et al. 2002. Are the stentless valves hemodynamically superior to stented valves? A prospective randomized trial. Ann Thorac Surg 73:767-78.nCzer LSC, Chaux A, Motloff JM, et al. 1990. Ten years experience with the St. Jude mechanical valve for primary valve replacement. J Thorac Cardiovasc Surg 100:44-5.nDavid TE, Ivanov J, Armstrong S, Feimdel CM, Cohen G. 2001. Late results of heart replacement with the Hancock 2 bioprostheses. J Thorac Cardiovasc Surg 121:268-77.nDel Rizzo DF, Wender O, Christakis GT, David TE. 1996. Hemodynamic benefits of the Toronto stentless valve. J Thorac Cardiovasc Surg 112:143-5.nDe Paulis R, Sommariva L, Colagrande L, et al. 1998. Regression of left ventricular hypertrophy after aortic valve replacement for aortic stenosis with different valve substitutes. J Thorac Cardiovasc Surg 116:590-8.nDevereux RB, Reichek N. 1977. Echocardiographic determination of left ventricular mass in man. Circulation 55:614-8.nFries R, Wender O, Schieffer H, Schäfers HJ. 2000. Comparative rest and exercise hemodynamic of 23 mm stentless versus 23 mm stented aortic bioprostheses. Ann Thorac Surg 69:817-22.nHammermeister K, Sethi GK, Hendersen MG, Glover FL, Prian C, Rahimtoola SH. 2000. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the veterans affair randomized trial. J Am Coll Cardiol 36:1152-8.nJin XY, Pepper JR. 2002. Do stentless valves make a difference? Eur J Cardiothorac Surg 22:95-100.nJin XY, Westaby S. 1999. Aortic root geometry and stentless porcine valve competence. Semin Thorac Cardiovasc Surg 11:145-50.nLevinson GE, Alpert JE. Aortic stenosis. 2000. In: Alpert JS, Dalen JE, Rahimtoola SH, eds. Valvular Heart Disease Philadelphia, PA: Lippincott, Williams, and Wilkins; 183-243.nLevy D, Garrison RJ, Savage DP, Kannel WB, Castelli WP. 1989. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: The Framingham Heart Study. Ann Intern Med 110:101-7.nPerez de Arenaza D, Lees B, Flather M, et al. 2005. Randomized comparison of stentless versus stented valves for aortic stenosis. Effects on left ventricular mass. Circulation 112:2696-702.nRao V, Jamieson WRE, Ivanov J, Armstrong S, David TE. 2000. Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation 102;(suppl III):III5-III9.nRe GW, Grunkemeier GL, Gately RL, Fumary AP, Starr A. 1995. Up to thirty-years survival after aortic valve replacement in the small aortic root. Ann Thorac Surg 59:1056-62.nSalcedo EE, Korzick DH, Curric PJ, Stewart WJ, Lever HM, Garmastic M. 1989. Determinants of left ventricular hypertrophy in patients with aortic stenosis. Clevel Clin J Med 56:590-6.nSchiller NB, Shah PM, Crawford M, et al. 1989. Recommendations for quantitation of the left ventricle by two dimensional echocardiography. J Am Soc Echocard 2:358-67.nWalther T, Falk V, Langerbartels G, Kruger M. 1999. Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy. Circulation 100(supp1 2II):II6-II10.nWestaby S, Horton M, Jin XY, et al. 2000. Survival advantage of stentless aortic bioprostheses, Oxford Heart Centre. Ann Thorac Surg 70:785-91.n



How to Cite

Tsialtas, D., Bolognesi, R., Beghi, C., Albertini, D., Bolognesi, M. G., Manca, C., & Gherli, T. (2007). Stented versus Stentless Bioprostheses in Aortic Valve Stenosis: Effect on Left Ventricular Remodelling. The Heart Surgery Forum, 10(3), E205-E210.