title: Long-Term Survival After Bovine Pericardial Versus Porcine Stented Bioprosthetic Aortic Valve Replacement: Does Valve Choice Matter?
abstract: BACKGROUND
  Bioprosthetic options are increasingly used for surgical aortic valve replacement (AVR). However, current decision making regarding bioprosthetic valve choice is not data-driven given incomplete information on comparative long-term outcomes after stented bovine pericardial (BoAVR) vs porcine (PoAVR) AVR. As such, this study sought to examine the effect of bioprosthetic valve choice on long-term survival and reoperation after AVR.
  
  
  METHODS
  A retrospective analysis of all stented bioprosthetic AVRs, with or without coronary artery bypass grafting procedures, at a single tertiary referral institution from 1980 to 2013 was conducted using a prospectively maintained database. Procedures were classified as BoAVR or PoAVR. The effect of valve type on long-term survival was assessed with Kaplan-Meier analysis and a Cox proportional hazard model. Subanalyses stratifying by valve size and patient age at the time of AVR assessing mortality and reoperation were also conducted.
  
  
  RESULTS
  We identified 2,010 stented bioprosthetic AVR patients, comprising 1,411 BoAVRs (70.2%) and 599 PoAVRs (29.8%), 868 (43.2%) of whom underwent concomitant coronary artery bypass grafting. Kaplan-Meier analysis (p = 0.12) and Cox models (hazard ratio BoAVR vs PoAVR, 1.08; p = 0.40) demonstrated no difference in long-term survival or need for reoperation after BoAVR vs PoAVR. Subanalyses of valve size and patient age also failed to show any association between valve choice and long-term survival or need for reoperation.
  
  
  CONCLUSIONS
  For patients undergoing AVR with a stented bioprosthetic valve, with or without coronary artery bypass grafting, the choice of a porcine vs bovine pericardial bioprosthesis does not appear to affect long-term survival or need for reoperation, regardless of valve size or patient age. As such, stented bioprosthetic valves would appear to be fungible, and therefore, valve choice should be driven by local market factors similar to other commodities.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Schechter
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Hanghang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Glower
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: gchad.hughes@duke.edu.
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002417:Cattle; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D010496:Pericardium / Q000637:transplantation; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013552:Swine; D013997:Time Factors