Leading expert in heart valve surgery, Dr. Jürgen Ennker, MD, explains the differences between stented and stentless aortic valves for heart valve replacement. He emphasizes the advantages of stentless valves, which are predominantly used in his practice. Dr. Ennker discusses how stentless valves, derived from pig aortic roots, offer benefits such as larger valve size compatibility, reduced transvalvular gradients, and decreased patient-prosthesis mismatch. He highlights the evolutionary advantage of stentless valves over man-made stented valves, which have been developed over the past few decades. Dr. Ennker also notes the ability of stentless valves to address aortic root aneurysms effectively.
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Choosing Between Stented and Stentless Aortic Valves for Replacement
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- Differences Between Stented and Stentless Aortic Valves
- Selecting the Right Aortic Valve for Patients
- Advantages of Stentless Aortic Valves
- Evolutionary Benefits of Stentless Valves
- Clinical Outcomes and Patient Feedback
- Full Transcript
Differences Between Stented and Stentless Aortic Valves
Dr. Jürgen Ennker, MD, explains that stented and stentless aortic valves differ primarily in their design and origin. Stented valves are man-made and have been developed over the last 40 to 50 years. In contrast, stentless valves are derived from pig aortic roots, reflecting millions of years of evolution. This natural design allows stentless valves to be implanted in larger sizes compared to stented valves, offering better compatibility with the patient's aortic annulus.
Selecting the Right Aortic Valve for Patients
Dr. Ennker predominantly uses stentless valves in over 98% of his patients. He reserves stented valves for cases where patients require mitral valve replacement, as the presence of a mitral valve can distort the aortic annulus, leading to insufficiency in stentless valves. The choice of valve type is crucial for ensuring optimal fit and function in each patient.
Advantages of Stentless Aortic Valves
Stentless aortic valves offer several advantages, according to Dr. Ennker. These include a larger valve size that fits better within the aortic annulus, a decreased transvalvular gradient, and a reduced risk of patient-prosthesis mismatch. These benefits contribute to improved hemodynamics and patient outcomes following valve replacement surgery.
Evolutionary Benefits of Stentless Valves
Dr. Ennker believes that the evolutionary design of stentless valves provides a significant advantage over stented valves. The natural structure of the pig aortic root has been refined over millions of years, offering a design that is inherently well-suited for human use. This contrasts with the relatively recent development of stented valves, which may not match the evolutionary sophistication of their stentless counterparts.
Clinical Outcomes and Patient Feedback
Dr. Ennker reports positive clinical outcomes and patient feedback with the use of stentless aortic valves. Patients often seek out these valves due to their benefits, such as the ability to eliminate aortic root aneurysms when implanted as a full root. The feedback from patients and cardiologists supports the preference for stentless valves in suitable cases, reinforcing their role in modern heart valve replacement surgery.
Full Transcript
Dr. Anton Titov, MD: Let's talk about the types of aortic valves for heart valve replacement that you use. There are stented versus stentless aortic valves. You have a particular interest in determining the best type of prosthetic heart valve for individual patients. You have studied the performance of stented versus stentless aortic valves in aortic valve replacement surgery. How do these types of heart valves differ from each other?
Dr. Anton Titov, MD: How do you decide which patient should get which type of aortic valve for replacement?
Dr. Jürgen Ennker, MD: I use a stentless valve predominately in more than 98% of patients. I only use a stented valve in patients who have to receive mitral valves because then the aortic annulus is distorted by the mitral valve. This results in the insufficiency of the stentless heart valve. In all other cases, I use stentless heart valves.
Dr. Jürgen Ennker, MD: Because you don't have the stent in the heart valve, this leads to the fact that you can implant a stentless valve. This valve is one to two sizes larger than a typical stented valve. This would fit into this specific patient's aortic annulus.
These stentless valves were created by nature. It's the pig aortic root. This was produced by evolution. Millions of years of evolution created this valve. Stented aortic valves are created by man over the last 40 or 50 years.
So, I've made up my mind. I think evolution is smarter than we are within 30 or 40 years. The follow-up with the patient and the feedback I receive from my patients and from my cardiologists support this view.
Dr. Jürgen Ennker, MD: Patients come exactly for this stentless aortic valve because they have an enlarged aortic annulus. They have a decreased transvalvular gradient. We also have a smaller percentage of patient-prosthesis mismatch.
We can eliminate aortic root aneurysms by implanting a freestyle valve as a full root. This is a big advantage for the patient.