Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis

M Broadwin, Department of Surgery, Lehigh Valley Health Network, 1200 South Ceder Crest Blvd, PA 18103, Allentown, USA.
N Ramkumar, Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, NH 03755, Hanover, USA.
D J. Malenka, Department of Medicine, Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, NH 03756, Lebanon, USA.
R D. Quinn, Department of Surgery, Cardiovascular Institute, Maine Medical Center, 22 Bramhall Street, ME 04102, Portland, USA.
C S. Ross, Department of Medicine, Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, NH 03756, Lebanon, USA.
F Hirashima, Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, 111 Colchester Avenue, VT 05401, Burlington, USA.
J D. Klemperer, Northern Light Cardiology, Northern Light Eastern Maine Medical Center, 417 State Street, ME 04401, Bangor, USA.
R S. Kramer, Department of Surgery, Cardiovascular Institute, Maine Medical Center, 22 Bramhall Street, ME 04102, Portland, USA.
G L. Sardella, Department of Surgery, Catholic Medical Center, 100 McGregor Street, NH 03102, Manchester, USA.
B Westbrook, Department of Surgery, Catholic Medical Center, 100 McGregor Street, NH 03102, Manchester, USA.
A W. Discipio, Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, NH 03756, Lebanon, USA.
A Iribarne, Department of Surgery, Cardiothoracic Surgery, Staten Island University Hospital at Northwell Health, 475 Seaview Avenue, NY 10305, Staten Island, USA.
M P. Robich, Johns Hopkins Hospital, Division of Cardiac Surgery, 1800 Orleans St, Zayed 7107, MD 21287, Baltimore, USA.

Document Type

Article

Publication Date

6-30-2023

Institution/Department

Cardiology

Journal Title

Cardiology research and practice

Abstract

INTRODUCTION: Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. . A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. RESULTS: In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; < 0.001), COPD (20% bovine vs. 27% porcine; =0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; =0.03), and coronary artery disease (65% bovine vs. 77% porcine; < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00-1.37; =050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23-1.32; =0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81-1.17; =0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20-1.47; =0.225)). CONCLUSIONS: In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching.

ISSN

2090-8016

First Page

2111843

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