Stented versus stentless aortic valve replacement in elderly: a systematic review and meta-analysis

Amer Harky, Jeffrey Shi Kai Chan, Mohammad Ahmad, Saied Froghi, Lara Rimmer, Mohamad Bashir


Background: Stentless aortic bioprostheses offer improved outcomes and long-term survival over stented aortic bioprostheses in aortic valve replacement (AVR). However, it remains unclear whether this improved outcome can also be demonstrated in elderly patients. This meta-analysis sought to determine whether stentless bioprosthetic valves improve clinical outcomes compared with stented valves in elderly patients undergoing AVR.
Methods: A comprehensive search was undertaken among PubMed, Embase, Scopus, and Ovid to identify all randomized and nonrandomized controlled trials available up to March 2017 comparing stentless to stented bioprosthetic valves in elderly patients undergoing AVR. Odds ratios (ORs), weighted mean differences, or standardized mean differences and their 95% confidence intervals (CIs) were analysed.
Results: A total of 1,048 patients were analysed and data extracted from six studies were suitable for meta-analysis. Average age was 77 years. The stented group displayed a significantly shorter cardiopulmonary bypass (P<0.0001; 95% CI: 0.424 to 1.05) and aortic cross clamp time (P<0.0001; 95% CI: 0.237 to 0.491) compared to the stentless group. There was no difference in the relative risks of stroke events (P=0.5074). In hospital mortality was significantly lower in the stentless group (P<0.0001). However, there was no difference in the 5-year mortality postoperatively for the two groups (P=0.835).
Conclusions: Our results showed that stentless aortic valves resulted in lower in-hospital and similar 5-year mortality compared to stented valves, despite less favourable operative data. They have also had better echocardiographic findings both while in hospital and at 6 months of follow up.