Root Replacement Using Stentless Valves in the Small Aortic Root: A Propensity Score Analysis

Background Root replacement using a stentless bioprosthesis may be the optimal approach to avoid patient-prosthesis mismatch in patients with a small aortic root. Primary root replacement, however, is considered to be associated with increased surgical risk. We compared early outcome of full root replacement with a stentless bioprosthesis with that of aortic valve replacement with a stented bioprosthesis using propensity score-matching analysis. Methods Of 231 patients undergoing elective, first-time aortic valve replacement with a small root (≤22 mm), 120 patients were selected using propensity score-matching analysis. They underwent either root replacement using a 23-mm stentless bioprosthesis (stentless group, n = 60) or supra-annular aortic valve replacement using a 21-mm stented bioprosthesis (stented group, n = 60). Preoperative characteristics and frequency of concomitant operations were identical. Results Duration of operation (196 ± 54 versus 174 ± 49 minutes), cardiopulmonary bypass (112 ± 36 versus 91 ± 33 minutes), and aortic cross-clamping (76 ± 21 versus 61 ± 21 minutes) were significantly longer in the stentless group. However, the need for perioperative transfusion and the incidence of postoperative reexploration for bleeding (3% versus 8%) was lower, and ventilation time was shorter. Mean duration of intensive care and hospital stay were also significantly shorter (2.3 ± 1.7 versus 4.0 ± 3.9 days, 8.9 ± 3.1 versus 12.4 ± 5.7 days). In-hospital mortality was identical (5% each). No independent predictor for in-hospital mortality was identified. Conclusions Full root replacement using a stentless bioprosthesis does not increase postoperative morbidity or mortality of aortic valve replacement and may be advantageous in patients with a small aortic root.