Influence of stentless versus stented valves on ventricular remodeling assessed at 6 months by magnetic resonance imaging and long-term follow-up

Abstract Background To compare the effect of stented versus stentless bioprostheses on left ventricular remodeling and assess their impact on long-term survival. Methods From January 2002 to December 2009, 62 severe aortic stenosis patients without coronary artery disease were randomized for bioprosthetic aortic valve replacement. After randomization, a cross-over was possible based on intraoperative data. Ventricular remodeling was studied by cardiovascular magnetic resonance imaging six months after surgery. Long-term survival was assessed by telephone survey. Results Thirty-five patients received a porcine Mosaïc® Medtronic bioprosthesis (Stented Group; Medtronic, Minneapolis, MN, USA) inserted using the usual supra-annular technique and 27 received a porcine Freestyle® Medtronic bioprosthesis (Stentless Group) inserted in the subcoronary position. Mean age was 75 ± 3 and 73 ± 4 years in the stentless and stented group, respectively. Nine patients who should have been implanted with a stentless bioprosthesis received a stented bioprosthesis for anatomical reasons. At 6 months, the left ventricular mass (LVM) decreased significantly in both groups (Stentless Group: 214.6 ± 56.1 g and 156.3 ± 23 g and Stented Group: 237 ± 75.7 g and 181 ± 53.3 g, respectively after surgery and at 6 months), this decrease was significantly greater in the stentless group ( p = 0.026). Reserve and coronary flow were increased in both groups at 6 months. Mean follow-up duration was 6.6 ± 3.0 years and 7.2 ± 4.0 years in the stentless and stented group, respectively. The 5-year actuarial survival was 87.5 ± 11.7% and 82.5 ± 17.1% for the stentless and stented group, respectively ( p = 0.81). Conclusion Porcine stentless prosthesis results in a better LVM regression than a stented valve at 6 months without changing the long-term survival.