Key result
Stentless valves did not display hemodynamic benefit in LV mass regression or postoperative mean gradients compared to stented valves, but showed lower peak gradients.
Why the study?
Do stentless valves improve cardiac hemodynamics compared to stented valves in adults undergoing aortic valve replacement?
Meta-Analysis
Do stentless valves improve cardiac hemodynamics compared to stented valves in adults undergoing aortic valve replacement?
Stentless valves do not provide superior hemodynamic benefits in terms of LV mass regression or mean gradients compared to stented valves, though they may offer lower peak gradients.
Stentless valves lack hemodynamic superiority over stented valves in AVR; challenges assumptions favoring their routine use for LV mass regression or mean gradients.
BACKGROUND: Several trials have compared stentless with stented valves following aortic valve replacement (AVR). The goal of this review was to systematically locate, critically appraise, and quantitatively combine results to determine if stentless valves improve cardiac hemodynamics. METHODS: We performed an unrestricted search of Pubmed Medline, EMBASE, CINAHL, the Cochrane databases, and EBM reviews. Article reference lists and online abstracts from major North American conferences were also searched. We included randomized trials of adults undergoing AVR that compared stentless and stented valves. Blinded reviewers performed assessment of trials for inclusion and trial quality. Two individuals performed data extraction independently. Kappa statistics were used to assess reviewer agreement. A random effects model was employed for statistical analyses. Assessments were made for postoperative, early, and late outcomes. Heterogeneity was explored with sensitivity analyses. RESULTS: Eight studies were identified for inclusion in the primary analysis, with four others included in sensitivity analyses. Baseline comparisons between groups revealed no differences. Our primary analyses revealed no differences between groups for assessments of LV mass or mean transvalvular gradients. Secondary analyses showed stentless valves to have lower peak gradients. Sensitivity analyses were supportive of our primary results. Heterogeneity was observed in some comparisons and sensitivity analyses failed to completely explain this heterogeneity. CONCLUSIONS: Stentless valves did not display hemodynamic benefit in terms of LV mass regression or postoperative mean gradients, but do appear to display superior hemodynamics in terms of peak gradients. Further well-designed and adequately powered trials are required to fully address this question.
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Payne et al. (2008) conducted a meta-analysis in Aortic valve replacement. Stentless valves vs. Stented valves was evaluated on LV mass or mean transvalvular gradients. Stentless valves did not display hemodynamic benefit in LV mass regression or postoperative mean gradients compared to stented valves, but showed lower peak gradients.
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