Aortic valve replacement: is the stentless xenograft an alternative to the homograft? midterm results

Background. This study was performed to assess the midterm clinical results after aortic valve replacement (AVR) with stentless xenograft (SX) compared with cryopreserved aortic or pulmonary homografts (HX). Methods. In 139 patients (< 60 years) undergoing elective AVR, 59 HX and 80 SX were inserted. All patients were followed clinically and by color flow Doppler echocardiography for 45 ± 12 months (range 31–58 months). Results. There were 5 in-hospital deaths (3.5%): 4 HX and 1 SX ( p = NS). The mean gradient was 6 ± 2 mm Hg in HX versus 13 ± 6 mm Hg in SX ( p < 0.001) and remained unchanged during follow-up. Actuarial survival (HX 77%, SX 80%), freedom from endocarditis (HX 91%, SX 99%), freedom from thromboembolic events (HX 98%, SX 90%), and freedom from reoperation (HX 98%, SX 100%) were comparable between groups after 58 months. Conclusions. Despite slightly higher transvalvular gradients, the stentless aortic valve achieved excellent midterm results, when compared with homografts.