Thorac cardiovasc Surg
DOI: 10.1055/s-0038-1676853
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Clinical Short-Term Outcome and Hemodynamic Comparison of Six Contemporary Bovine Aortic Valve Prostheses

Martin Hartrumpf
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Ralf-Uwe Kuehnel
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Filip Schroeter
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Robert Haase
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Magdalena L. Laux
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Roya Ostovar
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
,
Johannes M. Albes
1  Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, University Hospital Bernau, Bernau bei Berlin, Germany
› Author Affiliations
Further Information

Publication History

02 October 2018

20 November 2018

Publication Date:
22 January 2019 (online)

Abstract

Background Conventional stented valves (CV) remain gold standard for aortic valve disease. Bovine prostheses have been improved and rapid deployment valves (RDV) have arrived in the recent decade. We compare clinical and hemodynamic short-term outcome of six bovine valves.

Methods We retrospectively evaluated 829 consecutive patients (all-comers) receiving bovine aortic valve replacement (AVR). Four CV from different manufacturers (Mitroflow, Crown, Perimount, Trifecta) and two RDV (Perceval, Intuity) were compared in terms of pre-, intra-, and postprocedural data. A risk model for mortality was created.

Results All valves reduced gradients. From 23 mm, all CV showed acceptable gradients. Twenty-one millimeter Mitroflow/Perceval and 19 mm Crown showed above-average gradients. As baseline data differed, we performed propensity matching between aggregated isolated CV and RDV groups. Cardiopulmonary bypass (CPB), clamp, and surgery times were shorter with RDV (87.4 ± 34.0 min vs 111.0 ± 34.2, 54.3 ± 21.1 vs 74.9 ± 20.4, 155.2 ± 42.9 vs 178.0 ± 46.8, p < 0.001). New pacemaker rate (10.1 vs 1.3%, p = 0.016) and the tendency toward neurologic events (8.9 vs 2.5%, p = 0.086) were higher using RDV, induced mainly by the Perceval. Early mortality was equal (2.5 vs 1.3%, p = 0.560). Revision for bleeding, dialysis, blood products, length-of-stay, gradients, and regurgitation was also equal. Risk analysis showed that low valve size, low ejection fraction, endocarditis, administration of red cells, and prolonged CPB time were predictors of elevated mortality.

Conclusion Isolated bovine AVR has low mortality. Valves ≥ 23 mm show comparable gradients while the valve model matters < 23 mm. RDV should be used with care. Procedure-related times are shorter than those of CV but pacemaker implantation and neurologic events are more frequent (Perceval). Early mortality is low and valve performance comparable to CV.

Supplementary Material