Stentless Autograft/Homograft Aortic Valve Replacement

A valve is a mobile, thin sheet of tissue that ensures unidirectional flow through a passage. In the heart, valves can become insufficient or stenosed, leading to various health conditions. Valvular heart disease is a significant public health issue, affecting approximately 2.5% of the population. Among the various types of valvular heart disease, aortic valve disease, including aortic stenosis and regurgitation, is particularly prevalent. Damaged aortic valves are managed through medications, aortic valve repair, or surgical or transcatheter aortic valve replacement. Selecting an appropriate valve replacement strategy is crucial and depends on multiple factors, such as patient preference, age, anticoagulation tolerance, risk of valve deterioration, anticoagulation status, and future pregnancy plans.

Prosthetic heart valves used for aortic valve replacement are either mechanical or bioprosthetic. Mechanical heart valves include disc, bileaflet, and ball-and-cage types; bioprosthetic valves are categorized into xenografts (from animals), homografts (from the same species), and autografts (from the same individual). Bioprosthetic valves may be stented on metallic support or directly attached to the aorta. Stentless auto- and homograft aortic valve replacements have emerged as important surgical options for patients requiring valve replacement, offering distinct benefits compared to traditional stented prosthetic valves.

Although stent placement can reduce the aortic valve lumen and is not hemodynamically favorable, it does not significantly impact the clinical outcomes of stentless autograft and homograft valve types. This finding underscores the importance of considering hemodynamic performance and other patient-specific factors when selecting a valve replacement strategy. Moreover, different types of bioprosthetic valves exhibit similar mortality and reoperation rates, further highlighting the need for individualized patient care. Transcatheter aortic valve replacement offers a safer alternative for patients who aren't candidates for open-heart valve replacement surgery. However, stentless autograft and homograft aortic valve replacements remain valuable options for many patients, especially younger individuals and those with specific clinical indications.