Clinical Short-Term Outcome and Hemodynamic Comparison of Six Contemporary Bovine Aortic Valve Prostheses
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.
Eingereicht: 02. Oktober 2018
Angenommen: 20. November 2018
22. Januar 2019 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Fujita B, Ensminger S, Bauer T. et al; GARY Executive Board. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients. Eur J Cardiothorac Surg 2018; 53 (03) 552-559
- 2 Baumgartner H, Falk V, Bax JJ. et al; ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
- 3 Roumieh M, Ius F, Tudorache I. et al. Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: long-term results. Eur J Cardiothorac Surg 2015; 48 (01) 129-136
- 4 Glaser N, Jackson V, Franco-Cereceda A, Sartipy U. Survival after aortic valve replacement with bovine or porcine valve prostheses: a systematic review and meta-analysis. Thorac Cardiovasc Surg 2018 epub ahead of print
- 5 Kuehnel RU, Puchner R, Pohl A. et al. Characteristic resistance curves of aortic valve substitutes facilitate individualized decision for a particular type. Eur J Cardiothorac Surg 2005; 27 (03) 450-455 , discussion 455
- 6 Hartrumpf M, Kuehnel R, Erb M, Loladze G, Mueller T, Albes J. Favorable gradients with the Mitroflow aortic valve prosthesis in everyday surgery. Thorac Cardiovasc Surg 2012; 60 (05) 326-333 , discussion 333–334
- 7 Di Eusanio M, Phan K, Berretta P. et al. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients. Eur J Cardiothorac Surg 2018; 54 (04) 768-773
- 8 Ensminger S, Fujita B, Bauer T. et al; GARY Executive Board. Rapid Deployment versus conventional bioprosthetic valve replacement for aortic stenosis. J Am Coll Cardiol 2018; 71 (13) 1417-1428
- 9 Ugur M, Suri RM, Daly RC. et al. Comparison of early hemodynamic performance of 3 aortic valve bioprostheses. J Thorac Cardiovasc Surg 2014; 148 (05) 1940-1946
- 10 Bach DS. Echo/Doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC Cardiovasc Imaging 2010; 3 (03) 296-304
- 11 Mazine A, Teoh K, Bouhout I. et al. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol 2015; 31 (01) 63-68
- 12 Romano MA, Koeckert M, Mumtaz MA. et al; TRANSFORM Trial Investigators. Permanent pacemaker implantation after rapid deployment aortic valve replacement. Ann Thorac Surg 2018; 106 (03) 685-690
- 13 Liakopoulos OJ, Gerfer S, Weider S. et al. Direct comparison of the Edwards Intuity elite and Sorin Perceval S rapid deployment aortic valves. Ann Thorac Surg 2018; 105 (01) 108-114
- 14 Rahmanian PB, Kaya S, Eghbalzadeh K, Menghesha H, Madershahian N, Wahlers T. Rapid deployment aortic valve replacement: excellent results and increased effective orifice areas. Ann Thorac Surg 2018; 105 (01) 24-30
- 15 Davies RA, Bandara TD, Perera NK, Orr Y. Do rapid deployment aortic valves improve outcomes compared with surgical aortic valve replacement?. Interact Cardiovasc Thorac Surg 2016; 23 (05) 814-820
- 16 Smith AL, Shi WY, Rosalion A. et al. Rapid-deployment versus conventional bio-prosthetic aortic valve replacement. Heart Lung Circ 2017; 26 (02) 187-193
- 17 Greason KL, Lahr BD, Stulak JM. et al. Long-term mortality effect of early pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2017; 104 (04) 1259-1264
- 18 Nashef SA, Roques F, Sharples LD. et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (04) 734-744 , discussion 744–745
- 19 Reeves BC, Murphy GJ. Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery. Curr Opin Cardiol 2008; 23 (06) 607-612
- 20 Chen J, Lin Y, Kang B, Wang Z. Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch. Eur J Cardiothorac Surg 2014; 45 (02) 234-240
- 21 Takagi H, Ando T, Umemoto T. ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Direct and adjusted indirect comparisons of perioperative mortality after sutureless or rapid-deployment aortic valve replacement versus transcatheter aortic valve implantation. Int J Cardiol 2017; 228: 327-334