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Risk in Elderly Patients after Stentless versus Stented Aortic Valve Surgery

It was interesting to read the article, “Risk in elderly patients after stentless versus stented aortic valve surgery” written by Enker and colleagues. The stent-related problems of higher gradients, turbulent flow and susceptibility to infective endocarditis, paravalvular leaks and reoperations have not been dealt with in this article. The stentless valves are resistant to infections and, in our experience, ideal substitutes for patients with native or prosthetic valve endocarditis. That stentless valves are hemodynamically superior to stented valves has already been convincingly demonstrated. About the complexity of the technique of implantation, I must say, that when the root is small, especially in older people, implanting any valve, stentless or stented, is diffi cult. With suffi cient experience, and a standardised technique, implanting a stentless valve can no longer be that complex and diffi cult. We have brought down the aortic crossclamp time to about 60 minutes and our centre has an experience of implanting over 600 Medtronic Freestyle valves. The advantage is being able to put in a comparatively larger valve resulting in a rapid and better postoperative recovery and possibly improved survival.