Stented vs Stentless Aortic Valve Replacement in Elderly: A Systematic Review and Meta-analysis

Amer Harky, Mohamad Bashir, Barts Consortium Of Surgeons, Rakesh Uppal

Barts Heart Centre, St Bartholomews Hospital, London, United Kingdom

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Objective:

Stentless aortic bioprosthesis offer improved outcomes over stented aortic bioprosthetic valve replacement. However, it remains unclear whether this improved outcome can also be demonstrated in the cohort of elderly patients. This meta-analysis sought to determine whether stentless bioprosthetic valves improve clinical outcomes compared with stented valves in elderly patients undergoing aortic valve replacement (AVR).

Methods:

A systematic search was undertaken over four major electronic databases (PubMed, Embase, Scopus and Ovid) to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in elderly patients undergoing aortic valve replacement available up to March 2017. Cox-proportional harzard ratio aligning Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analysed.

Results:

A total of 1048 patients from six comparative studies were analysed. Average age of the cohort was 77 yrs. Stented AVR group had a significant shorter CPB (P <0.0001; 95% CI: 0.424 to 1.05) and aortic cross clamp time (P < 0.0001; 95% CI: 0.24 to 0.5) compared to the stentless group. There was no difference in relative risk for CVA events (P=0.67). In hospital mortality was significantly lower in the stentless group (P < 0.0001). However, there was no difference in the 5years mortality post-operative period between the two groups (P=0.835).

Conclusion:

Stented AVR offers superiority amongst operative outcomes, however, there was no demonstrable long term mortality benefits between the two groups.