Comparison of porcine versus bovine pericardial bioprosthesis in the mitral position

Abstract

Background There are no reports of midterm outcomes after mitral valve replacement with a 25‐mm bioprosthesis in a large series of patients. This study aimed to examine perioperative and midterm outcomes of bioprosthetic valve choice, porcine or bovine pericardial, in the mitral position, focusing on 25‐mm valves. Methods From 2007 to 2018, 467 patients received a mitral bioprosthesis, with or without concomitant procedures. Of these, 111 (23.8%) were porcine, and 356 (76.2%) were bovine pericardial, and 219 patients (46.9%) received a 25‐mm valve. A propensity‐matched cohort of 192 patients was used for outcome analyses. The influence of the valve type on midterm survival and incidence of cardiac death was assessed. Similarly, subanalysis stratified by valve size was conducted. Results In matched patients, there were no differences in midterm survival and incidence of cardiac death between the two groups (log‐rank test; p = .268 and p = .097, respectively). There were no differences in midterm survival and incidence of cardiac death between the 25‐mm valve and larger valve (log‐rank test; p = .563 and p = .597, respectively). The Cox proportional‐hazards model revealed that the valve type and 25‐mm valve did not affect midterm survival (p = .487 and p = .375, respectively) and incidence of cardiac death (p = .678 and p = .562, respectively). Conclusions The choice of a porcine or bovine pericardial bioprosthesis does not affect midterm survival and cardiac death. The 25‐mm valves, whether bovine or porcine, could be an appropriate alternative when the patient's body size is small.

The serendipity history of a bioprosthesis in mitral position: An incessant competition among manufacturers having no winner

“…In contrast with Tsubota et al, 1 Raman et al 3 evidenced that postoperative gradient is similar among the two types of the prosthesis while long‐term survival was improved in the porcine group. Interestingly, reintervention was significantly higher in patients with a bovine prosthesis.…”

“…In the present issue, Tsubota et al 1 present the outcomes of 96 pairs of matched patients after mitral valve replacement. Midterm survival, cardiac death incidence, and perioperative complications did not differ among the two groups.…”

“…This commentary refers to the manuscript entitled "Comparison of porcine versus bovine pericardial bioprosthesis in the mitral position" by Tsubota et al 1 The outcomes of porcine versus bovine bioprosthesis have continuously and persistently been a matter of debate. It is indeed an endless competition among manufacturers of bioprosthesis with newly improved and better-performing designs being produced every year.…”

“…This commentary refers to the manuscript entitled “Comparison of porcine versus bovine pericardial bioprosthesis in the mitral position” by Tsubota et al 1 …”

“…This brings attention to two important topics such as the type of prosthesis choice and the lack of impact of an increased transvalvular gradient on short and midterm survival. However, Tsubota et al 1 have provided the literature with valuable data that could have an impact in the future.…”