COMPARISON OF PORCINE BIOLOGICAL VALVES WITH PERICARDIAL VALVES - A 12-YEAR CLINICAL-EXPERIENCE WITH 2223 BIO-PROSTHESES

In order to evaluate selective differences of biological porcine valves versus pericardial valves and to analyze various valve models, 8 different bioprostheses (4 porcine valves, 4 pericardial valves) were studied in a 12-year follow-up. From 1978 to 1990, 476 porcine bioprostheses (Carpentier-Edwards: n=104, Carpentier Edwards Supraanular: n=59, Hancock I: n=41, Hancock II: n=272) and 647 pericardial valves (Hancock-Extracorporeal: n=479, Ionescu-Shiley: n=76, Carpentier-Edwards: n=57, Mitroflow: n=35) were implanted. At time of implantation, the patient age ranged from 21-85 years, mean 57.1+/-12.4 years. 831 patients were analyzed in the long-term follow-up (62.3+/-18.6 months, cumulative follow-up of 6632 patient-years). The incidences of thromboembolic complications (TE), endocarditis (E), primary tissue failure (PTF), rate of reoperation (ReOp), and late mortality due to prosthesis dysfunction were analyzed, calculated, and compared within the different valve models (actuarial data, (2)(chi) test, log rank analysis). The incidences of TE and E were tower for pericardial valves when compared with porcine bioprostheses (TE: 0.88 vs. 1.8%/patient year; E: 0.24 vs. 0.5%/patient year); within the 2 groups, the different valve models did not show any major differences. However, the incidence of PTF was significantly higher in the pericardial valve group, being 36+/-6.5%, 68+/-10% and 86+/-19.5% after 6, 8, and 10 years; the respective figures for the porcine valves were 6+/-3.5%, 18+/-7.1%, and 60+/-13.1% (p < 0.001). Consequently, ReOp rate was 3.6%/patient-year in pa patients with pericardial valves and thus significantly higher than in those having porcine valves (1.5%/patient year, p < 0.01). The late mortality due to PTF was significantly higher in the pericardial valve group than in the porcine group (0.74% vs. 0.33%/patient-year, p < 0.01). Obviously due to primarily better hemodynamic results, pericardial valves showed a lower incidence of thromboembolic complications and endocarditis. With regard to long-term durability and primary tissue failure (PTF), the results were significantly better in the porcine valve group; consequently the reoperation rate and PTF-related late mortality was lower in the recipients of porcine bioprostheses. Inter-model differences could only be elaborated among the pericardial valves: significant differences were only found for PTF.