Korean Circ J.  2022 Feb;52(2):136-146. 10.4070/kcj.2021.0223.

Pericardial Versus Porcine Valves for Surgical Aortic Valve Replacement

• Shin HJ
• Kim WK
• Kim JK
• Kim JB
• Jung SH
• Choo SJ
• Chung CH
• Lee JW

• KMID: 2525453
• DOI: http://doi.org/10.4070/kcj.2021.0223

Abstract

Background and Objectives
There still are controversies on which type between bovine pericardial and porcine valves is superior in the setting of aortic valve replacement (AVR). This study aims to compare clinical outcomes of AVR using between pericardial or porcine valves.
Methods
The study involved consecutive 636 patients underwent isolated AVR using stented bioprosthetic valves between January 2000 and May 2016. Of these, pericardial and porcine valves were implanted in 410 (pericardial group) and 226 patients (porcine group), respectively. Clinical outcomes including survival, structural valve deterioration (SVD) and trans-valvular pressure gradient were compared between the groups. To adjust for potential selection bias, inverse probability treatment weighting (IPTW) was conducted.
Results
The mean follow-up duration was 60.1±50.2 months. There were no significant differences in the rates of early mortality (3.1% vs. 3.1%; p=0.81) and SVD (0.3%/patient-year [PY] vs. 0.5%/PY; p=0.33) between groups. After adjustment using IPTW, however, landmark mortality analyses showed a significantly lower late (>8 years) mortality risk in pericardial group over porcine group (hazard ratio [HR], 0.61; 95% confidence interval, [CI] 0.41–0.90; p=0.01) while the risks of SVD were not significantly difference between groups (HR, 0.45; 95% CI, 0.12–1.70; p=0.24). Mean pressure gradient across prosthetic AV was lower in the Pericardial group than the Porcine group at both immediate postoperative point and latest follow-up (p values <0.001).
Conclusions
In patients undergoing bioprosthetic surgical AVR, bovine pericardial valves showed superior results in terms of postoperative hemodynamic profiles and late survival rates over porcine valves.

Keyword

Aortic valve; Bioprosthesis

Figure

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  Figure 1 (A) Unadjusted overall survival rates between pericardial and porcine groups. The 5- and 10-year survival rates were 82.2% and 56.3%, respectively in the pericardial group, and were 86.5% and 64.9%, respectively in the porcine group. (B) Unadjusted freedom from SVD between pericardial and porcine groups.SVD = structural valve deterioration.

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  Figure 2 Adjusted freedom from structural valve deterioration using inverse probability treatment weighting modeling between pericardial and porcine groups.SVD = structural valve deterioration; HR = hazard ratio; CI = confidence interval.

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  Figure 3 Landmark survival plots for unadjusted groups (A, B) and adjusted groups by inverse-probability treatment weighting (C, D) across 8 years following surgery between the pericardial and the porcine groups: (A) crude within 8 years, (B) crude beyond 8 years, (C) adjusted within 8 years and (D) adjusted beyond 8 years following surgery.

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  Figure 4 Changes in mean pressure gradients across the aortic valve over time (preoperative, early postoperative, last follow-up) in pericardial group (A) and porcine group (B).

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