Editorial comment
The place of a stentless aortic bioprosthetic valve
O lugar de uma bioprótese aórtica sem stent
Pedro M. Correia
Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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"apellidos" => "Leite-Moreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918303519?idApp=UINPBA00004E" "url" => "/21742049/0000003700000010/v1_201810310641/S2174204918303519/v1_201810310641/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The place of a stentless aortic bioprosthetic valve" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "819" "paginaFinal" => "820" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro M. Correia" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Pedro M." "apellidos" => "Correia" "email" => array:1 [ 0 => "pedrocorreia202@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O lugar de uma bioprótese aórtica sem <span class="elsevierStyleItalic">stent</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite progress in prosthetic valve manufacturing and the different types of valves that have appeared in the last two decades, the ideal replacement valve is yet to be found. Stentless aortic bioprosthetic valves were introduced to overcome some of the disadvantages of stented valves, particularly to improve hemodynamics, by increasing the effective orifice area, and to increase durability. Despite some enthusiasm, the greater technical demands of implanting stentless aortic valves have favored the widespread use of stented valves, leaving stentless valves with advantages in patients with a small aortic root or impaired left ventricular function, in whom the better hemodynamics of the stentless valve may result in better long-term results.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The study by Andrade et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> describes the short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves in a single-center experience. The authors present a retrospective cohort involving 345 patients regardless of primary indication for surgery or concomitant procedures. The perioperative results were good, as was the hemodynamic performance of the valve at six months, as demonstrated by the low mean gradient and large effective orifice area, and also reflected in the low incidence of patient-prosthesis mismatch. Concerning long-term follow-up, the high survival and low rate of structural valve degeneration and endocarditis are encouraging, although a period longer than six years is warranted to confirm these expectations. As pointed out by the authors, the results are similar to previously published findings,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> and may suffer from selection bias that could affect comparisons with stented bioprostheses.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The way to change the paradigm of surgical options and bring about more widespread use of stentless valves is to prove that the more technically demanding, and thus potentially riskier, procedure is more beneficial to patients. In fact, current stentless valves are less demanding to implant, due to the simplified single suture line. Data comparing the Freedom Solo with stented valves have been recently published. Wollersheim et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> compared outcomes of the Freedom Solo and the Mitroflow bioprosthetic valve in patients with a small aortic root. Cross-clamp times for isolated replacement procedures were similar, around 80 min, and eight-year survival did not differ between groups, although the stentless valve had an impressive 0% cumulative incidence of aortic valve reoperation at seven years compared to 7.1% for the stented valve. Christ et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> compared the hemodynamic performance of the Freedom Solo to that of a stented valve (Labcor Dokimos Plus) and found no significant difference in effective orifice area. Finally, from the same group as the present paper, Cerqueira et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> compared the stentless Freedom Solo to the stented Trifecta. In a propensity-matched population, the stented valve showed a better hemodynamic profile, although reverse remodeling and six-year survival were comparable between the groups.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dealing with small aortic roots, the potential for patient-prosthesis mismatch, and the desire to improve the hemodynamics of bioprostheses have long been concerns of surgeons. Aortic root enlargement to enable placement of a larger prosthesis has also proved to be feasible and effective.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The sutureless aortic prosthesis recently appeared as an option with apparently excellent hemodynamics, reducing cross-clamp and cardiopulmonary bypass times and facilitating minimally invasive surgery and complex cardiac interventions.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The exponential growth of transcatheter aortic valve implantation has added this technique to an already complex equation.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> While the data presented by the authors enrich the literature, it is likely that only randomized trials and longer follow-up times can give a clear view of the place of the Freedom Solo stentless aortic bioprosthetic valve in valve replacement surgery.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Which patients benefit from stentless aortic valve replacement?" 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Branco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur J Cardio-thoracic Surg" "fecha" => "2016" "volumen" => "50" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Gersak" 1 => "T. Fischlein" 2 => "T.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 27 | 31 | 58 |
| 2024 September | 41 | 30 | 71 |
| 2024 August | 34 | 27 | 61 |
| 2024 July | 28 | 30 | 58 |
| 2024 June | 23 | 28 | 51 |
| 2024 May | 22 | 19 | 41 |
| 2024 April | 24 | 31 | 55 |
| 2024 March | 19 | 19 | 38 |
| 2024 February | 23 | 22 | 45 |
| 2024 January | 30 | 24 | 54 |
| 2023 December | 18 | 26 | 44 |
| 2023 November | 24 | 22 | 46 |
| 2023 October | 11 | 11 | 22 |
| 2023 September | 21 | 16 | 37 |
| 2023 August | 18 | 25 | 43 |
| 2023 July | 11 | 9 | 20 |
| 2023 June | 17 | 11 | 28 |
| 2023 May | 28 | 26 | 54 |
| 2023 April | 15 | 3 | 18 |
| 2023 March | 39 | 18 | 57 |
| 2023 February | 29 | 20 | 49 |
| 2023 January | 16 | 15 | 31 |
| 2022 December | 32 | 25 | 57 |
| 2022 November | 33 | 27 | 60 |
| 2022 October | 38 | 19 | 57 |
| 2022 September | 23 | 37 | 60 |
| 2022 August | 21 | 19 | 40 |
| 2022 July | 27 | 40 | 67 |
| 2022 June | 15 | 25 | 40 |
| 2022 May | 24 | 31 | 55 |
| 2022 April | 23 | 30 | 53 |
| 2022 March | 23 | 44 | 67 |
| 2022 February | 21 | 23 | 44 |
| 2022 January | 16 | 23 | 39 |
| 2021 December | 18 | 36 | 54 |
| 2021 November | 18 | 32 | 50 |
| 2021 October | 29 | 42 | 71 |
| 2021 September | 18 | 22 | 40 |
| 2021 August | 20 | 26 | 46 |
| 2021 July | 12 | 19 | 31 |
| 2021 June | 23 | 14 | 37 |
| 2021 May | 21 | 36 | 57 |
| 2021 April | 46 | 35 | 81 |
| 2021 March | 30 | 16 | 46 |
| 2021 February | 28 | 17 | 45 |
| 2021 January | 23 | 23 | 46 |
| 2020 December | 25 | 12 | 37 |
| 2020 November | 22 | 12 | 34 |
| 2020 October | 12 | 12 | 24 |
| 2020 September | 22 | 11 | 33 |
| 2020 August | 19 | 6 | 25 |
| 2020 July | 17 | 15 | 32 |
| 2020 June | 14 | 10 | 24 |
| 2020 May | 15 | 9 | 24 |
| 2020 April | 13 | 10 | 23 |
| 2020 March | 14 | 9 | 23 |
| 2020 February | 21 | 20 | 41 |
| 2020 January | 7 | 4 | 11 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 12 | 7 | 19 |
| 2019 October | 13 | 6 | 19 |
| 2019 September | 8 | 6 | 14 |
| 2019 August | 9 | 7 | 16 |
| 2019 July | 14 | 11 | 25 |
| 2019 June | 19 | 13 | 32 |
| 2019 May | 18 | 3 | 21 |
| 2019 April | 18 | 18 | 36 |
| 2019 March | 8 | 13 | 21 |
| 2019 February | 19 | 15 | 34 |
| 2019 January | 11 | 12 | 23 |
| 2018 December | 23 | 19 | 42 |
| 2018 November | 47 | 31 | 78 |
| 2018 October | 2 | 2 | 4 |
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