Stented vs Stentless Aortic Valve Replacement in Patients with Small Aortic Root: 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: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective:

To determine whether stentless bioprosthetic aortic valve replacement(AVR) improve clinical outcomes compared to stented AVR in patients with small aortic roots.

Methods:

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

Results:

A total of 965 patients from 7 studies conformed to our inclusion criteria and were used in the synthesis of this meta-analysis. There was mix and observed heterogeneity amongst reported studies. Mean age of the cohort was 73 yrs. There was no difference observed for CPB time (P=0.54), aortic cross clamp time (P=0.89), ICU stay (P=0.57), rate of PPM insertion (0.74) and rates of sternal wound infections (0.97) post operatively. Length of stay was significantly shorter in the stentless group (P=0.02). There was a significant increased risk of reoperation in the stented group (P=0.001).

Conclusion:

The present meta-analysis shows that there are no significant peri-operative differences in using stented or stentless aortic valve bioprosthesis in the cohort of small aortic root patients, a further randomized control trial is necessary