Comparison of Porcine Biological Valves with Pericardial Valves - a 12-Year Clinical Experience with 1123 Bio-Prostheses

Abstract

In order to evaluate selective differences of biological porcine valves versus pericardial valves and to analyze various valve models, 8 different bioprostheses (4 porcine valves, 4 pericardial valves) were studied in a 12-year follow-up. From 1978 to 1990, 476 porcine bioprostheses (Carpentier-Edwards: n = 104, Carpentier Edwards Supraanular: n = 59, Hancock I: n = 41, Hancock II: n = 272) and 647 pericardial valves (Hancock-Extracorporeal: n = 479, Ionescu-Shiley: n = 76, Carpentier-Edwards: n = 57, Mitroflow: n = 35) were implanted. At time of implantation, the patient age ranged from 21-85 years, mean 57.1 +/- 12.4 years. 831 patients were analyzed in the long-term follow-up (62.3 +/- 18.6 months, cumulative follow-up of 6632 patient-years). The incidences of thromboembolic complications (TE), endocarditis (E), primary tissue failure (PTF), rate of reoperation (ReOp), and late mortality due to prosthesis dysfunction were analyzed, calculated, and compared within the different valve models (actuarial data, chi 2 test, log rank analysis). The incidences of TE and E were lower for pericardial valves when compared with porcine bioprostheses (TE: 0.88 vs. 1.8%/patient year; E: 0.24 vs. 0.5%/patient year); within the 2 groups, the different valve models did not show any major differences. However, the incidence of PTF was significantly higher in the pericardial valve group, being 36 +/- 6.5%, 68 +/- 10% and 86 +/- 19.5% after 6, 8, and 10 years; the respective figures for the porcine valves were 6 +/- 3.5%, 18 +/- 7.1%, and 60 +/- 13.1% (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristic resistance curves of aortic valve substitutes facilitate individualized decision for a particular type

“…During the last 15 years stented biological aortic valve substitutes have been investigated in an astounding number of publications [1][2][3][6][7][8]. It was shown that both types of biological valves demonstrate reasonable hemodynamic performance in the clinical setting [1][2][3]6].…”

“…It was shown that both types of biological valves demonstrate reasonable hemodynamic performance in the clinical setting [1][2][3]6]. It was also shown that the observed differences in transvalvular gradients were not followed by significant differences in left ventricular remodelling as well as clinical outcome [7].…”

“…Instead, evidence was accumulated that left ventricular muscle mass regression as one of the key indicators for adequate clinical recovery of the heart did not differ significantly [20,[16][17]. Investigations, however, further revealed that degeneration of biological valves appeared after a typical time frame of 8-15 years notwithstanding the particular valve type [3]. Fortunately, it was also demonstrated that elderly patients fared reasonably well with biological valves in terms of longevity and quality of life [6,7].…”

“…As elder patients do exhibit a considerable susceptibility regarding cerebral or intestinal hemorrhage as well as bone injuries lifelong avoidance of anticoagulation has gained renewed interest [2]. As much evidence has been accumulated determining the average patency rates of biological valves to appear in the proximity of 10-12 years surgeons are increasingly inclined to offer biological valves to their elderly patients assuming that the life expectance may very well match the patency of the prosthesis while offering a reasonable quality of life wihout the inherent risks of coumarin derivatives [3]. In the routine setting stented aortic valves appear to be preferably used because they facilitate and expedite implantation thereby reducing operative risks [4,5].…”

“…Valves constructed from bovine pericardium aligned on an artifical frame as well as porcine valves mounted on an artificial scaffold [6]. In numerous studies it has been shown that both valve types demonstrate a comparable clinical short and long term performance particularly in the aortic position [3,[6][7][8][9]. Although pericardial valve substitutes tend to exhibit lower transvalvular gradients the assumed differential hydraulic behaviour has not yet been sufficiently and comprehensively revealed.…”