title: Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?
abstract: BACKGROUND
  Pericardial bioprostheses have favorable echocardiographic hemodynamics in the aortic position compared with porcine valves; however, there are few data comparing clinical outcomes. Our objective was to assess the late results of the two valve types.
  
  
  METHODS
  We reviewed 2,979 patients aged 65 years or older undergoing aortic valve replacement with pericardial (n=1,976) or porcine (n=1,003) prostheses between January 1993 and December 2007. The most common pericardial prostheses were Carpentier-Edwards Perimount and Mitroflow, and the most common porcine valves were Medtronic Mosaic, Carpentier-Edwards, Hancock modified orifice, and St. Jude Biocor. Follow-up extended to a maximum of 16 years (mean, 5.2±3.5 years).
  
  
  RESULTS
  Survival at 5, 10 and 12 years was, respectively, 68%, 33%, and 21% overall, was 68%, 30%, and 16% for patients with pericardial bioprosthesis, and was 69%, 38% and 27% for the porcine group. In a multivariate model, long-term survival was reduced in patients with diabetes, renal failure, prior myocardial infarction, congestive heart failure, and older age, but late survival was not higher in the pericardial valve group. Overall freedom from reoperation was 96%, 92%, and 90% at 5, 10, and 12 years, and freedom from explant was 98%, 96%, and 94% during the same period. The reason for explant was structural valve deterioration in 50 patients (2%).
  
  
  CONCLUSIONS
  Despite the better hemodynamic performance documented in prior investigations, pericardial valves do not confer any survival advantage over porcine valves in patients aged 65 years or older undergoing aortic valve replacement.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sameh M
authors.initials: SM
authors.lastname: Said
authors.forename: Elena
authors.initials: E
authors.lastname: Ashikhmina
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate