Comparison of Long-Term Performance of Porcine versus Pericardial Bioprostheses

Background. The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) is debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series (N=3,983 cases). Methods. From a prospectively collected database we included 3,983 recipients of two current porcine bioprostheses (porcine group) or one current pericardial bioprosthesis (pericardial group). We evaluated the long-term freedom from SVD (Structural Valve Deterioration) with both Kaplan-Meier and competing risks methods (primary endpoint). We distinguished between SVD and patient-prosthesis mismatch (PPM). Secondary endpoints were late survival, freedom from valve-related mortality, freedom from reoperation for SVD, freedom from NSVD (Nonstructural Valve Dysfunction) and freedom from endocarditis. Results. Median follow-up was 10.4 years (99.7% complete, 32,219 patient/years). Overall survival was significantly lower in the porcine group (p=0.002), related to baseline intergroup differences. At ten years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0%±0.3 vs. 96.3%±0.8) (p=0.003). Competing risks freedom from SVD at ten years was 98.6%±0.2 and 97.2%±0.6 (porcine and pericardial group, respectively) (p=0.001). The porcine group displayed higher rate of PPM. Conclusion. Despite augmented risk of PPM compared to pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. On the other hand, PPM may negatively impact the survival beyond 10 years follow-up. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy and clinical context.

Publication History

Received: 24 August 2024

Accepted after revision: 17 December 2024

Accepted Manuscript online:
07 January 2025