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Mid-term outcomes of patients undergoing bovine versus porcine isolated surgical aortic valve replacement
Yancheng Dai1, Edgar Aranda-Michel1, James A. Brown1, Derek Serna-Gallegos2, Forozan Navid2, Pyongsoo Yoon2, David Kaczorowski2, Danny Chu2, Ibrahim Sultan2.
1Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 2Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

BACKGROUND: There are conflicting data on the superiority of the type of bioprosthetic valve in the aortic position. While porcine valves may offer hemodynamic advantages, their failure mode may require urgent interventions. This study sought to determine the impact of bovine vs. porcine aortic valves on long-term survival and readmissions after aortic valve replacement.
METHODS: A retrospective analysis of all isolated aortic valve replacement with bovine or porcine valves at our institution from 2010 to 2020 was conducted via a prospectively maintained database. Patients with previous valve surgeries were excluded. Propensity matching (1:1) was performed to ensure similar baseline characteristics between the two groups. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess long-term mortality. Competing risk regression was performed to assess all cause readmission.
RESULTS: 1532 patients underwent isolated surgical aortic valve replacement in the time period. Of these, 1115 (72.8%) received a bovine valve, while 417 (27.2%) received a porcine valve. Propensity matching yielded 417 risk-adjusted pairs. The bovine group and porcine group were similar across baseline comorbidities (SMD<0.1). On Kaplan-Meier estimates, there was no difference in survival between the two groups throughout the study period (p=0.78). This trend was maintained on multivariable Cox regression (Table 1) (p=0.97). Competing risk regression demonstrated no difference in cardiac-related readmissions between patients who received a bovine valve vs. porcine valve (p=0.74).
CONCLUSIONS: These findings suggest that, for patients undergoing isolated aortic valve replacement, the choice of a bovine vs. porcine valve may not affect mid-term survival or readmission risk.

Multivariable Cox proportional hazard regression model for long-term survival
VariableHazardRatio95% CIP-value
Bovine (vs. porcine)1.010.73, 1.390.972
Age (years)1.051.03, 1.07<0.001
Body surface area0.390.19, 0.780.008
Chronic dialysis use2.981.00, 8.870.049
Severe chronic lung disease1.791.26, 2.56<0.001
Infective endocarditis5.122.59, 10.13<0.001
Prior cerebrovascular accident1.891.33, 2.68<0.001
Existing atrial fibrillation1.781.28, 2.49<0.001
Urgent surgical status (ref: elective)1.861.33, 2.60<0.001



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