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Hawley H. Seiler Resident Award Paper

Do Pericardial Bioprostheses Improve Outcome of Elderly Patients Undergoing Aortic Valve Replacement?

^a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
^b Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
^c Division of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts

Accepted for publication January 6, 2012.

^_* Address correspondence to Dr Schaff, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Email: schaff{at}mayo.edu).

Presented at the Fifty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 9–12, 2011.

Background: Pericardial bioprostheses have favorable echocardiographic hemodynamics in the aortic position compared with porcine valves; however, there are few data comparing clinical outcomes. Our objective was to assess the late results of the two valve types.

Methods: We reviewed 2,979 patients aged 65 years or older undergoing aortic valve replacement with pericardial (n = 1,976) or porcine (n = 1,003) prostheses between January 1993 and December 2007. The most common pericardial prostheses were Carpentier-Edwards Perimount and Mitroflow, and the most common porcine valves were Medtronic Mosaic, Carpentier-Edwards, Hancock modified orifice, and St. Jude Biocor. Follow-up extended to a maximum of 16 years (mean, 5.2 ± 3.5 years).

Results: Survival at 5, 10 and 12 years was, respectively, 68%, 33%, and 21% overall, was 68%, 30%, and 16% for patients with pericardial bioprosthesis, and was 69%, 38% and 27% for the porcine group. In a multivariate model, long-term survival was reduced in patients with diabetes, renal failure, prior myocardial infarction, congestive heart failure, and older age, but late survival was not higher in the pericardial valve group. Overall freedom from reoperation was 96%, 92%, and 90% at 5, 10, and 12 years, and freedom from explant was 98%, 96%, and 94% during the same period. The reason for explant was structural valve deterioration in 50 patients (2%).

Conclusions: Despite the better hemodynamic performance documented in prior investigations, pericardial valves do not confer any survival advantage over porcine valves in patients aged 65 years or older undergoing aortic valve replacement.

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				G. L. Grunkemeier, A. P. Furnary, Y. Wu, L. Wang, and A. Starr Durability of pericardial versus porcine bioprosthetic heart valves J. Thorac. Cardiovasc. Surg., December 1, 2012; 144(6): 1381 - 1386. [Abstract] [Full Text] [PDF]

				R. M. Suri, H. I. Michelena, H. M. Burkhart, K. L. Greason, R. C. Daly, J. A. Dearani, S. J. Park, L. D. Joyce, J. M. Stulak, T. M. Sundt III, et al. A prospective, randomized comparison of 3 contemporary bioprosthetic aortic valves: Should hemodynamic performance influence device selection? J. Thorac. Cardiovasc. Surg., December 1, 2012; 144(6): 1387 - 1398. [Abstract] [Full Text] [PDF]