The Heart Valve Society

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Pericardial versus Porcine Valves for Surgical Aortic Valve Replacement
Joon Bum Kim, Hee Jung Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee.
Asan Medical Center, Seoul, Korea, Republic of.

OBJECTIVE:
There still are controversies whether superior hemodynamic profiles of the stented bovine pericardial valves over the porcine valve in the setting of aortic valve replacement (AVR) may be translated into improved clinical outcomes in the long-term. This study aims to compare clinical outcomes between the pericardial and porcine AVR.
METHODS:
The study involved consecutive 541 adult patients (71.86.5yrs; 273 females) undergoing isolated AVR using commercially available stented bioprosthetic valves between 2000 and 2016. Of these, pericardial and porcine valves were implanted in 354 (Pericardial group) and 187 patients (Porcine group), respectively. To reduce the impact of selection bias between these two groups, propensity score matching was conducted based on all measurable baseline covariates.
RESULTS:
Early mortality rates were 1.9% and 1.6% in the Pericardial and Porcine groups, respectively (P=0.759). Indexed effective valve orifice area (iEOA) was significantly larger in the Pericardial group than the Porcine group (1.13+/-0.26 vs. 0.83+/-0.11, P<0.001). During follow-up (43.3+/-40.2 months), 107 deaths and 35 valve-related complications including 13 cases of aortic valve reoperations occurred in the overall cohort. Overall 10-year survival rates were 58.77.0% in the Porcine group and 62.46.4% in the Pericardial group (P=0.759). Although there was no significant difference in the rate of overall incidence of valve-related complications (P=0.220), the Pericardial group showed significantly superior reoperation-free rate compared with the Porcine group (P=0.007, Figure). Propensity score matching yielded 156 pairs of patients well balanced for 27 baseline profiles. After matching, two groups showed comparable survival (HR, 1.07; 95% CI0.65-1.76; P=0.798), however, the Pericardial group showed superior reoperation-free rate compared with the Porcine group (HR, 0.17; 95% CI, 0.01-0.98; P=0.048; Figure).
CONCLUSIONS:
The pericardial valve showed superior iEOA as well as improved reoperation-free rate in the AVR compared with the porcine valves.


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