Stentless porcine valves yielded similar left ventricular mass index at 6 months compared to stented valves (142 vs 131 g/m2), despite greater reductions in peak aortic velocity (P<0.001).
RCT (n=190)
Does a stentless porcine valve improve left ventricular mass regression compared to a stented porcine valve in adults undergoing aortic valve replacement for severe aortic stenosis?
Stentless porcine valves do not provide superior left ventricular mass regression compared to stented valves at 6 or 12 months, despite offering better hemodynamic profiles.
Absolute Event Rate: 142% vs 131%
BACKGROUND: Aortic valve replacement (AVR) is the established treatment for severe aortic stenosis. In response to the long-term results of aortic homografts, stentless porcine valves were introduced as an alternative low-resistance valve. We conducted a randomized trial comparing a stentless with a stented porcine valve in adults with severe aortic stenosis. METHODS AND RESULTS: The primary outcome was change in left ventricular mass index (LVMI) measured by transthoracic echocardiography and, in a subset, by cardiovascular MR. Measurements were taken before valve replacement and at 6 and 12 months. Patients undergoing AVR with an aortic annulus < or =25 mm in diameter were randomly allocated to a stentless (n=93) or a stented supra-annular (n=97) valve. There were no significant differences in mean LVMI between the stentless versus stented groups at baseline (176+/-62 and 182+/-63 g/m2, respectively) or at 6 months (142+/-49 and 131+/-45 g/m2, respectively), although within-group changes from baseline to 6 months were highly significant. Changes in LVMI measured by cardiovascular MR (n=38) were consistent with the echo findings. There was a greater reduction in peak aortic velocity (P<0.001) and a greater increase in indexed effective orifice area (P<0.001) in the stentless group than in the stented group. There were no differences in clinical outcomes between the 2 valve groups. CONCLUSIONS: Despite significant differences in indexed effective orifice area and peak flow velocity in favor of the stentless valve, there were similar reductions in left ventricular mass at 6 months with both stented and stentless valves, which persisted at 12 months.
Arenaza et al. (Tue,) conducted a rct in Severe aortic stenosis (n=190). Stentless porcine valve vs. Stented supra-annular porcine valve was evaluated on Change in left ventricular mass index (LVMI). Stentless porcine valves yielded similar left ventricular mass index at 6 months compared to stented valves (142 vs 131 g/m2), despite greater reductions in peak aortic velocity (P<0.001).