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PubMed · 12103380

Do stentless valves make a difference?

Xu Y Jin·John R Pepper
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Abstract

Stentless glutaraldehyde-preserved bioprosthetic valves for the aortic position were introduced into clinical practice in 1988. Their introduction coincided with the publication of several long-term observational studies of aortic homografts, which showed superior freedom from structural valve damage compared to the first generation stented porcine bioprosthesis. There followed 10 years of intensive investigation into the haemodynamic characteristics of stentless valves. These studies have demonstrated superior haemodynamic features in terms of transvalvular pressure gradients, effective orifice area, and more complete regression of left ventricular hypertrophy. Despite these advantages, stentless valves have yet to be adopted widely. This review seeks to explain this paradox.

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Aortic Valve StenosisBioprosthesisHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansHypertrophy, Left VentricularProsthesis DesignRisk AssessmentTreatment OutcomeVentricular Function, LeftJournal ArticleReview

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BibTeXRIS

Xu Y Jin, John R Pepper. 2002. Do stentless valves make a difference?. https://doi.org/10.1016/s1010-7940(02)00195-1

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PubMed2026

Transvalvular Flow Rate is Associated With Mortality Rate and Lifetime Loss in Aortic Valve Stenosis: A Meta-Analysis of Reconstructed Time-to-Event Data.

Low-flow states are associated with adverse outcomes in aortic stenosis (AS), but the prognostic value of transvalvular flow rate (TFR) has not been consistently established across studies. This study is a systematic review and meta-analysis of reconstructed time-to-event data was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. PubMed/MEDLINE, EMBASE, and Cochrane Library were searched for studies (published by November 14, 2025) comparing low versus normal TFR in AS. Data were collected from Kaplan-Meier curves. The primary endpoint was all-cause mortality. Survival was assessed using pooled Kaplan-Meier curves, Cox regression, flexible parametric survival models, and restricted mean survival time (RMST) analysis. A total of 9 studies including 6,494 patients were analyzed; 2,575 (39.7%) had low TFR. At 8 years of follow-up, estimated survival was 34.1% (95% confidence interval [CI] 24.7% to 47%) in the low-TFR group and 63% (95% CI 58.9% to 67.4%) in the normal-TFR group. Low TFR was associated with higher all-cause mortality (hazard ratio 1.59, 95% CI 1.45 to 1.74, p < 0.001). We observed a progressively greater hazard over time, with the hazard ratio approaching 1.9 by 8 years. At 8 years, RMST in the normal-TFR group was 7.37 years (95% CI 7.21 to 7.53 years) versus 5.07 years (95% CI 4.91 to 5.23 years) in the low-TFR group, representing a lifetime loss of 2.3 years in the low-TFR group (&#x394;RMST -2.30 years, 95% CI -2.53 to -2.07 years, p < 0.001). In patients with AS, low TFR is associated with significantly higher mortality and lifetime loss. These findings support TFR as a clinically meaningful marker for risk stratification in AS.

Aortic Valve Stenosis↗