Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?

Sameh M. Said, Elena Ashikhmina, Kevin L. Greason, Rakesh M. Suri, Soon J. Park, Richard C. Daly, Harold M. Burkhart, Joseph A. Dearani, Thoralf M. Sundt, Hartzell V Schaff

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1868-1875
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number6
DOIs
StatePublished - Jun 2012

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Bioprosthesis
Aortic Valve
Swine
Survival
Prostheses and Implants
Hemodynamics
Reoperation
Renal Insufficiency
Heart Failure
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement? / Said, Sameh M.; Ashikhmina, Elena; Greason, Kevin L.; Suri, Rakesh M.; Park, Soon J.; Daly, Richard C.; Burkhart, Harold M.; Dearani, Joseph A.; Sundt, Thoralf M.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 93, No. 6, 06.2012, p. 1868-1875.

Research output: Contribution to journalArticle

Said, SM, Ashikhmina, E, Greason, KL, Suri, RM, Park, SJ, Daly, RC, Burkhart, HM, Dearani, JA, Sundt, TM & Schaff, HV 2012, 'Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?', Annals of Thoracic Surgery, vol. 93, no. 6, pp. 1868-1875. https://doi.org/10.1016/j.athoracsur.2012.01.061
Said, Sameh M. ; Ashikhmina, Elena ; Greason, Kevin L. ; Suri, Rakesh M. ; Park, Soon J. ; Daly, Richard C. ; Burkhart, Harold M. ; Dearani, Joseph A. ; Sundt, Thoralf M. ; Schaff, Hartzell V. / Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 6. pp. 1868-1875.
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title = "Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?",
abstract = "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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T1 - Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?

AU - Said, Sameh M.

AU - Ashikhmina, Elena

AU - Greason, Kevin L.

AU - Suri, Rakesh M.

AU - Park, Soon J.

AU - Daly, Richard C.

AU - Burkhart, Harold M.

AU - Dearani, Joseph A.

AU - Sundt, Thoralf M.

AU - Schaff, Hartzell V

PY - 2012/6

Y1 - 2012/6

N2 - 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.

AB - 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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