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" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204918303568" "doi" => "10.1016/j.repce.2018.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918303568?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305747?idApp=UINPBA00004E" "url" => "/08702551/0000003700000010/v3_201912041818/S0870255117305747/v3_201912041818/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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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 4 | 4 | 8 |
| 2024 Outubro | 29 | 24 | 53 |
| 2024 Setembro | 38 | 25 | 63 |
| 2024 Agosto | 35 | 29 | 64 |
| 2024 Julho | 35 | 24 | 59 |
| 2024 Junho | 23 | 17 | 40 |
| 2024 Maio | 28 | 14 | 42 |
| 2024 Abril | 27 | 28 | 55 |
| 2024 Maro | 30 | 22 | 52 |
| 2024 Fevereiro | 26 | 25 | 51 |
| 2024 Janeiro | 20 | 21 | 41 |
| 2023 Dezembro | 20 | 23 | 43 |
| 2023 Novembro | 49 | 33 | 82 |
| 2023 Outubro | 19 | 25 | 44 |
| 2023 Setembro | 25 | 18 | 43 |
| 2023 Agosto | 28 | 23 | 51 |
| 2023 Julho | 24 | 12 | 36 |
| 2023 Junho | 20 | 14 | 34 |
| 2023 Maio | 40 | 24 | 64 |
| 2023 Abril | 19 | 7 | 26 |
| 2023 Maro | 50 | 25 | 75 |
| 2023 Fevereiro | 28 | 19 | 47 |
| 2023 Janeiro | 15 | 17 | 32 |
| 2022 Dezembro | 41 | 23 | 64 |
| 2022 Novembro | 31 | 32 | 63 |
| 2022 Outubro | 40 | 23 | 63 |
| 2022 Setembro | 20 | 34 | 54 |
| 2022 Agosto | 22 | 33 | 55 |
| 2022 Julho | 25 | 46 | 71 |
| 2022 Junho | 17 | 27 | 44 |
| 2022 Maio | 19 | 26 | 45 |
| 2022 Abril | 25 | 33 | 58 |
| 2022 Maro | 28 | 36 | 64 |
| 2022 Fevereiro | 19 | 30 | 49 |
| 2022 Janeiro | 16 | 24 | 40 |
| 2021 Dezembro | 20 | 25 | 45 |
| 2021 Novembro | 18 | 39 | 57 |
| 2021 Outubro | 29 | 43 | 72 |
| 2021 Setembro | 17 | 28 | 45 |
| 2021 Agosto | 17 | 28 | 45 |
| 2021 Julho | 16 | 30 | 46 |
| 2021 Junho | 11 | 14 | 25 |
| 2021 Maio | 20 | 31 | 51 |
| 2021 Abril | 14 | 23 | 37 |
| 2021 Maro | 39 | 30 | 69 |
| 2021 Fevereiro | 34 | 11 | 45 |
| 2021 Janeiro | 22 | 24 | 46 |
| 2020 Dezembro | 11 | 13 | 24 |
| 2020 Novembro | 13 | 15 | 28 |
| 2020 Outubro | 20 | 26 | 46 |
| 2020 Setembro | 25 | 6 | 31 |
| 2020 Agosto | 15 | 10 | 25 |
| 2020 Julho | 16 | 27 | 43 |
| 2020 Junho | 14 | 10 | 24 |
| 2020 Maio | 34 | 6 | 40 |
| 2020 Abril | 37 | 24 | 61 |
| 2020 Maro | 39 | 8 | 47 |
| 2020 Fevereiro | 73 | 29 | 102 |
| 2020 Janeiro | 52 | 6 | 58 |
| 2019 Dezembro | 32 | 5 | 37 |
| 2019 Novembro | 13 | 8 | 21 |
| 2019 Outubro | 22 | 8 | 30 |
| 2019 Setembro | 47 | 6 | 53 |
| 2019 Agosto | 12 | 5 | 17 |
| 2019 Julho | 23 | 13 | 36 |
| 2019 Junho | 15 | 13 | 28 |
| 2019 Maio | 16 | 11 | 27 |
| 2019 Abril | 16 | 12 | 28 |
| 2019 Maro | 6 | 13 | 19 |
| 2019 Fevereiro | 5 | 9 | 14 |
| 2019 Janeiro | 10 | 10 | 20 |
| 2018 Dezembro | 13 | 19 | 32 |
| 2018 Novembro | 58 | 50 | 108 |
| 2018 Outubro | 18 | 19 | 37 |
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