Survival after Aortic Valve Replacement with Bovine or Porcine Valve Prostheses: A Systematic Review and Meta-AnalysisFunding This work was supported by grants from Karolinska Institutet Foundations and Funds (grant number 2016fobi47721 to US), the Mats Kleberg Foundation (grant number 2017–00096 to US), the Swedish Heart-Lung Foundation (grant numbers 20160522 and 20160525 to US), the Swedish Heart and Lung Association (grant number E101/16 to US and NG), Regional ALF agreement between Stockholm County Council and Karolinska Institutet (grant number 20160329 to US), Capio Research Foundation (grant number 2016–2898 to NG), Åke Wiberg Foundation (grant number M16–0081 to US), and Magnus Bergvall Foundation (grant number 2016–01396 to US) as well as a donation from Mr. Fredrik Lundberg (to AF-C).
20 February 2018
27 March 2018
17 May 2018 (online)
Background Bovine and porcine bioprostheses are commonly used for surgical aortic valve replacement. It is unknown if the long-term survival differs between the two valve types.
We performed a systematic review and meta-analysis to compare survival in patients who underwent aortic valve replacement and received a bovine or a porcine prosthesis.
Methods We performed a systematic search of Medline, Embase, Web of Science, and the Cochrane Library. Cohort studies that compared survival between patients who underwent aortic valve replacement and received either a bovine or a porcine bioprosthesis and that reported overall long-term survival with hazard ratio (HR) and 95% confidence interval (CI) were included. Two authors independently reviewed articles considered for inclusion, extracted the information from each study, and performed the quality assessment. We performed a meta-analysis using a random effects model to calculate the pooled HR (95% CI) for all-cause mortality. We did sensitivity analyses to assess the robustness of our findings.
Results Seven studies published between 2010 and 2015 were included, and the combined study population was 49,190 patients. Of these, 32,235 (66%) received a bovine, and 16,955 (34%) received a porcine bioprosthesis. There was no significant difference in all-cause mortality between patients who received a bovine compared with a porcine bioprosthesis (pooled HR 1.00, 95% CI: 0.92–1.09). Heterogeneity between studies was moderate (55.8%, p = 0.04).
Conclusions This systematic review and meta-analysis suggest no difference in survival between patients who received a bovine versus a porcine bioprosthesis after aortic valve replacement. Our study provides valuable evidence for the continuing use of both bovine and porcine bioprosthetic valves for surgical aortic valve replacement.
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