title: Effect of bioprostheses anti-calcification treatment: comparative follow-up between Mitroflow LX and Magna pericardial xenografts using a propensity score-weighted analysis.
abstract: The efficacy of anti-calcification treatment of bioprosthetic heart valves remains unclear. The aim of this study was to compare the clinical outcomes between Mitroflow LX valve, without anti-calcification treatment, and the Carpentier-Edwards Perimount Magna (P-Magna), with anti-calcification treatment.
  
  
  
  Between 2005 and 2012, 625 consecutive patients underwent aortic valve replacement either with a Mitroflow LX ( n  = 329) or a P-Magna ( n  = 296). Variables regarding patient-related risk factors and operative data were accounted for an inverse probability of treatment weighting analysis. Then, adjusted survival outcomes and the rate of structural valve disease (SVD) were assessed for each group.
  
  
  
  Mean follow-up times were 4.1 ± 2.29 years and 3.9 ± 2.63 years, respectively ( P  = 0.34). Adjusted overall survival rate was higher in the P-Magna group than in the Mitroflow LX group at 8 years (69.1% vs 51.9%, respectively) [HR = 1.44, 95% CI: 1.01 to 2.06; P  = 0.0467]. Similarly, the 8-year cardiac-related survival rate was also higher in the P-Magna group [HR = 1.99, 95% CI: 1.19 to 3.32; P  = 0.0083]. One patient (0.8%) with P-Magna and 23 patients (18.5%) with Mitroflow LX group developed SVD (0.24% per patient-year vs 4.5% per patient-year, respectively; P  < 0.001). At 5 and 8 years, valve-related survival rates did not differ significantly between both groups [HR = 1.67, 95% CI: 0.95 to 2.95; P  = 0.075].
  
  
  
  The P-Magna prosthesis showed significantly better overall and cardiac-related survival than the Mitroflow LX. The higher early SVD and reoperation rates seen with the Mitroflow LX prosthesis did not impact negatively on valve-related survival.
authors.affiliation: Department of Cardiac Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Arnau
authors.initials: A
authors.lastname: Blasco-Lucas
authors.affiliation: Department of Cardiac Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Permanyer
authors.affiliation: Reparative Therapy of the Heart, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: María-Llanos
authors.initials: ML
authors.lastname: Pérez
authors.affiliation: Department of Cardiac Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Gracia-Baena
authors.affiliation: Division of Cardiology,Medical College of Wisconsin,Children's Hospital of Wisconsin,Milwaukee,Wisconsin,United States of America.
authors.forename: Remedios
authors.initials: R
authors.lastname: Ríos
authors.affiliation: Reparative Therapy of the Heart, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Kelly
authors.initials: K
authors.lastname: Casós
authors.affiliation: Department of Cardiac Surgery, University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.|Reparative Therapy of the Heart, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Galiñanes
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D002114:Calcinosis / Q000175:diagnosis / Q000517:prevention & control*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D064593:Heterografts; D006801:Humans; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D011474:Prosthesis Design; D013997:Time Factors
keywords: Anti-calcification treatment; Aortic bioprosthesis; Degeneration; Magna; Mitroflow