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J Am Coll Cardiol, 2004; 44:384-388, doi:10.1016/j.jacc.2004.01.053
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ANTI-INFLAMMATORY THERAPY IN CORONARY ARTERY DISEASE

Durability of pericardial versus porcine aortic valves

Guangqiang Gao, MD*, YingXing Wu, MD*,*, Gary L. Grunkemeier, PhD*, Anthony P. Furnary, MD* and Albert Starr, MD*

* Providence Health System, Portland, Oregon, USA

Manuscript received August 22, 2003; revised manuscript received December 30, 2003, accepted January 27, 2004.

* Reprint requests and correspondence: Dr. YingXing Wu, 9205 SW Barnes Road, #33LL, Portland, Oregon 97225, USA.
YingXing.Wu{at}providence.org

OBJECTIVES: This study compares the long-term performance of the Carpentier-Edwards (CE) porcine bioprosthesis and the CE pericardial bioprosthesis for aortic valve replacement (AVR).

BACKGROUND: With new bioprostheses on the horizon, there is renewed interest in how the long-term durability of current pericardial bioprostheses compares with the traditional porcine bioprosthesis.

METHODS: We reviewed 518 AVR with CE porcine valves from 1974 to 1996 and 1,021 AVR with CE pericardial valves from 1991 to 2002. The age distribution and clinical profiles were similar for both groups. The total (mean) follow-up was 3,322 (6.4) years for porcine and 2,556 (2.5) years for pericardial.

RESULTS: Long-term mortality was similar (p = 0.29) for porcine and pericardial, with 10-year survival rates of 34 ± 2% and 38 ± 6%, respectively. Ten-year freedom from major adverse cardiac events was also similar for both (respectively): thromboembolism (80 ± 2% and 87 ± 2%; p = 0.24); endocarditis (98 ± 1% and 99 ± 1%; p = 0.30). However, 10-year freedom from explant was lower for porcine (90 ± 2%) than for pericardial (97 ± 1%, p = 0.04). Reasons for explant for porcine were structural valve deterioration (SVD) (n = 25), endocarditis (n = 4), and periprosthetic leak (n = 2). The reasons for explant for pericardial were SVD (n = 4), endocarditis (n = 4) and periprosthetic leak (n = 1).

CONCLUSIONS: The current CE pericardial valve offers better midterm durability than the traditional CE porcine valve. Its freedom from SVD and reoperation makes it our current bioprosthesis of choice for AVR in appropriately selected patients.

Abbreviations and Acronyms
  AVR = aortic valve replacement
  CE = Carpentier-Edwards
  FDA = Food and Drug Administration
  KM = Kaplan-Meier
  SVD = structural valve deterioration




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