Abstract
Background The long-term comparative results between porcine and pericardial bioprostheses for
surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning
direct comparative evaluation among contemporary devices. We compared late and very
late results in a single center series (n = 3,983 cases).
Methods From a prospectively collected database we included 3,983 recipients of two current
porcine bioprostheses (porcine group) or one current pericardial bioprosthesis (pericardial
group). We evaluated the long-term freedom from structural valve deterioration (SVD)
with both Kaplan–Meier and competing risk methods (primary endpoint). We distinguished
between SVD and patient-prosthesis mismatch (PPM). Secondary endpoints were late survival,
freedom from valve-related mortality, freedom from reoperation for SVD, freedom from
nonstructural valve dysfunction (NSVD) and freedom from endocarditis.
Results Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall
survival was significantly lower in the porcine group (p = 0.002), related to baseline intergroup differences. At 10 years, Kaplan–Meier freedom
from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8;
p = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6
(porcine and pericardial group, respectively; p = 0.001). The porcine group displayed a higher rate of PPM.
Conclusion Despite the augmented risk of PPM compared with pericardial valves, in this series
porcine bioprostheses seem to perform better concerning protection from late (>10
years) SVD. Smaller valve sizes (19–21 mm) may negatively impact the SVD risk among
porcine valves but not among pericardial valves. These elements need to be considered
for valve choice and surgical strategy in SAVR candidates according to their life
expectancy, clinical context, and annulus size.
Keywords
aortic valve - bioprosthesis - structural valve dysfunction - patient-prosthesis mismatch
