Key result
Aortic valve replacement with pulmonary autografts, stentless bioprostheses, mechanical valves, or stented bioprostheses resulted in comparable left ventricular mass regression at 12 months across all age groups.
Why the study?
Does the type of aortic valve prosthesis affect left ventricular mass regression and hemodynamics in patients with isolated aortic valve stenosis across different age groups?
RCT (n=120)
Open-label
Randomized
No
Does the type of aortic valve prosthesis affect left ventricular mass regression and hemodynamics in patients with isolated aortic valve stenosis across different age groups?
Pulmonary autografts provide superior hemodynamics compared to mechanical valves in young patients, but stentless bioprostheses offer no significant hemodynamic or left ventricular mass regression advantage over stented or mechanical valves in older patients.
Valve choice for AVR can prioritize durability or anticoagulation needs over LVM regression expectations; confirms no prosthesis-specific advantage across ages.
BACKGROUND: We assessed the hemodynamic performance of various prostheses and the clinical outcomes after aortic valve replacement, in different age groups. METHODS: One-hundred-and-twenty patients with isolated aortic valve stenosis were included in this prospective randomized randomised trial and allocated in three age-groups to receive either pulmonary autograft (PA, n = 20) or mechanical prosthesis (MP, Edwards Mira n = 20) in group 1 (age < 55 years), either stentless bioprosthesis (CE Prima Plus n = 20) or MP (Edwards Mira n = 20) in group 2 (age 55-75 years) and either stentless (CE Prima Plus n = 20) or stented bioprosthesis (CE Perimount n = 20) in group 3 (age > 75). Clinical outcomes and hemodynamic performance were evaluated at discharge, six months and one year. RESULTS: In group 1, patients with PA had significantly lower mean gradients than the MP (2.6 vs. 10.9 mmHg, p = 0.0005) with comparable left ventricular mass regression (LVMR). Morbidity included 1 stroke in the PA population and 1 gastrointestinal bleeding in the MP subgroup. In group 2, mean gradients did not differ significantly between both populations (7.0 vs. 8.9 mmHg, p = 0.81). The rate of LVMR and EF were comparable at 12 months; each group with one mortality. Morbidity included 1 stroke and 1 gastrointestinal bleeding in the stentless and 3 bleeding complications in the MP group. In group 3, mean gradients did not differ significantly (7.8 vs 6.5 mmHg, p = 0.06). Postoperative EF and LVMR were comparable. There were 3 deaths in the stented group and no mortality in the stentless group. Morbidity included 1 endocarditis and 1 stroke in the stentless compared to 1 endocarditis, 1 stroke and one pulmonary embolism in the stented group. CONCLUSIONS: Clinical outcomes justify valve replacement with either valve substitute in the respective age groups. The PA hemodynamically outperformed the MPs. Stentless valves however, did not demonstrate significantly superior hemodynamics or outcomes in comparison to stented bioprosthesis or MPs.
No takes yet. Share an insight, caveat, or question.
Doss et al. (2011) conducted an RCT in Isolated aortic valve stenosis (n=120). Pulmonary autograft or Stentless bioprosthesis vs. Mechanical valve or Stented bioprosthesis was evaluated on Left ventricular mass index at 12 months (Group 1: pulmonary autograft vs mechanical valve, g/m2) (p=NS). Aortic valve replacement with pulmonary autografts, stentless bioprostheses, mechanical valves, or stented bioprostheses resulted in comparable left ventricular mass regression at 12 months across all age groups.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: