Clinical Short-Term Outcome and Hemodynamic Comparison of Six Contemporary Bovine Aortic Valve Prostheses

Objectives: Despite transcatheter aortic valve implantation, conventional valves (CVs) remain the gold standard for aortic valve disease. Stented prostheses have been improved and rapid deployment valves (RDVs) have arrived in the recent decade. We compare clinical short-term outcome of six contemporary bovine valves.

Methods: We evaluated 829 consecutive patients (all-comers) receiving bovine aortic valve replacement with or without concomitant procedures. Four CVs from different manufacturers (Mitroflow, Crown, Perimount, Trifecta) and two RDVs (Perceval, Intuity) were compared as to pre-, intra-, and postprocedural data. A risk model was created.

Results: All valves reduced gradients remarkably. From 23 mm, all CV showed acceptable gradients, Trifecta consistently having the lowest; 21 mm Mitroflow and Perceval valves and the 19 mm Crown valve showed above-average gradients. As baseline data differed greatly, we performed propensity matching between aggregated isolated CV and RDV groups. Cardiopulmonary bypass (CPB), clamp, and surgery times were significantly shorter with RDV (87.4 vs. 111.0 minutes, 54.3 vs. 74.9, 155.2 vs. 178.0). Partial sternotomy was used more often with RDV (45.6% vs. 5.1%, p < 0.001). Concerns were raised with the high new pacemaker rate (10.1 vs 1.3%, p = 0.016) and the tendency toward an elevated rate of neurologic events (8.9% vs 2.5%, p = 0.086) using RDV. Subgroup analysis showed that this was induced mainly by the Perceval prosthesis, while the Intuity behaved similar to CV. Early mortality was not different between the groups (2.5 vs. 1.3%, p = 0.560). Revision for bleeding, new dialysis, use of blood products, length of stay, valve gradients, and regurgitation also were not different. Multivariable risk analysis showed that low valve size, low EF, presence of endocarditis, administration of red blood cells, and prolonged CPB time were predictors of elevated early mortality.

Conclusions: Isolated AVR with bovine valves can be safely performed with low mortality. Generally, mortality is predicted by valve size rather than valve model. Valves ≥ 23 mm show comparable gradients, while the valve model does matter at sizes < 23 mm. Gradients are lowest using the Trifecta valve. RDV are efficient but should be used with care. Their procedure-related times are shorter than those of CV but pacemaker rate is significantly higher and neurologic events are more likely, particularly using the Perceval. However, early mortality is low and valve performance is comparable to CV. RDV are suited for minimally invasive surgery.