Pericardial and porcine stentless aortic valves: are they hemodynamically different?
BACKGROUND
We sought to compare the early hemodynamic performance of pericardial stentless aortic valves with that of well-established porcine stentless aortic prostheses.


METHODS
A total of 169 patients (97 men and 72 women, aged 73+/-6 years) undergoing aortic valve replacement received either a pericardial (Pericarbon, Sorin Biomedica, Saluggia, Italy; n = 89) or a porcine (Freestyle, Medtronic, n = 80) stentless aortic valve. Aortic valve hemodynamics and root dynamism were assessed by Doppler echocardiography at discharge and 12 months after implantation.


RESULTS
Clinical demographic data, valve size (24.0+/-1.9 vs 24.6+/-2.3 mm), and body surface area (1.85+/-0.19 vs 1.80+/-0.19 m2) did not differ between porcine and pericardial valves (both p > 0.05). The 1-year postoperative mean valve pressure gradient (4.2+/-2.6 vs 3.7+/-2.6 mm Hg), effective orifice area (2.2+/-0.8 vs 2.2+/-0.8 cm2), and left ventricular ejection fraction (62+/-13 vs 63+/-13, %) also did not differ (all p > 0.05). However, at discharge, systolic increase in aortic sinus diameter was significantly greater in pericardial valves than in porcine ones (7.7+/-5.7 vs 4.9%+/-4.2%, p < 0.01). Furthermore, pericardial valves had a greater slope of effective orifice area-systolic aortic flow relationship (0.89+/-0.07 vs 0.70+/-0.06, cm2/100 mL/s, p < 0.01).


CONCLUSIONS
Nonprosthetic thin-walled pericardial valves appear to offer better aortic root dynamism and more efficient hemodynamics than those of porcine valves immediately after implant. At 1-year follow-up, however, both types of stentless valves provide equally excellent hemodynamics. The clinical choice between the two will depend on their long-term durability.
Jin
X Y
XY
Department of Cardiac Surgery, Oxford Heart Centre, Oxford Radcliffe Hospitals, United Kingdom. x.y.jin@btinternet.com
Westaby
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D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents; D015996:Survival Rate