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(Circulation. 2005;112:2696-2702.)
© 2005 American Heart Association, Inc.

Vascular Medicine

Randomized Comparison of Stentless Versus Stented Valves for Aortic Stenosis

Effects on Left Ventricular Mass

Diego Perez de Arenaza, MD; Belinda Lees, PhD; Marcus Flather, MB, BS, FRCP; Fiona Nugara, BSc; Trygve Husebye, MD; Marek Jasinski, MD, PhD; Marek Cisowski, MD, PhD; Mohammed Khan, MSc, MPH; Michael Henein, MD; Jullien Gaer, MB, BS, FRCS; Levant Guvendik, MD, FRCS; Andrzej Bochenek, MD, PhD; Stanislaw Wos, MD, PhD; Mons Lie, MB, BS, MD; Guido Van Nooten, MD, PhD; Dudley Pennell, MD, FRCP; John Pepper, MA, MChir, FRCS, on behalf of the ASSERT (Aortic Stentless versus Stented valve assessed by Echocardiography Randomized Trial) Investigators

From the Royal Brompton and Harefield NHS Trust, London, UK (D.P.d.A., B.L., M.F., F.N., M.K., M.H., J.G., D.P., J.P.); Hospital Italiano, Buenos Aires, Argentina (D.P.d.A.); National Heart and Lung Institute, Imperial College, London, UK (B.L., M.F., M.K., M.H., D.P., J.P.); Ullevaal Sykehus, Oslo, Norway (T.H., M.L.); Medical University of Silesia, Katowice, Poland (M.J., M.C., A.B., S.W.); Castle Hill Hospital, Hull, UK (L.G.); and UZ Gent, Gent, Belgium (G.V.N.).

Correspondence to Professor J. Pepper, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK. E-mail j.pepper{at}rbh.nthames.nhs.uk

Received March 21, 2005; revision received May 26, 2005; accepted June 13, 2005.

Background— Aortic valve replacement (AVR) is the established treatment for severe aortic stenosis. In response to the long-term results of aortic homografts, stentless porcine valves were introduced as an alternative low-resistance valve. We conducted a randomized trial comparing a stentless with a stented porcine valve in adults with severe aortic stenosis.

Methods and Results— The primary outcome was change in left ventricular mass index (LVMI) measured by transthoracic echocardiography and, in a subset, by cardiovascular MR. Measurements were taken before valve replacement and at 6 and 12 months. Patients undergoing AVR with an aortic annulus 25 mm in diameter were randomly allocated to a stentless (n=93) or a stented supra-annular (n=97) valve. There were no significant differences in mean LVMI between the stentless versus stented groups at baseline (176±62 and 182±63 g/m², respectively) or at 6 months (142±49 and 131±45 g/m², respectively), although within-group changes from baseline to 6 months were highly significant. Changes in LVMI measured by cardiovascular MR (n=38) were consistent with the echo findings. There was a greater reduction in peak aortic velocity (P<0.001) and a greater increase in indexed effective orifice area (P<0.001) in the stentless group than in the stented group. There were no differences in clinical outcomes between the 2 valve groups.

Conclusions— Despite significant differences in indexed effective orifice area and peak flow velocity in favor of the stentless valve, there were similar reductions in left ventricular mass at 6 months with both stented and stentless valves, which persisted at 12 months.

Key Words: echocardiography • hypertrophy • magnetic resonance imaging • stenosis • valves

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