Amedeo Anselmi, Morgan Daniel, Marie Aymami, Celine Chabanne, Sebastien Rosier, Julien Mancini, Jean Philippe Verhoye
{"title":"猪与心包生物假体的长期性能比较。","authors":"Amedeo Anselmi, Morgan Daniel, Marie Aymami, Celine Chabanne, Sebastien Rosier, Julien Mancini, Jean Philippe Verhoye","doi":"10.1055/a-2505-8447","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series (<i>n</i> = 3,983 cases).</p><p><strong>Methods: </strong> 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 structural valve deterioration (SVD) with both Kaplan-Meier and competing risk 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 nonstructural valve dysfunction (NSVD) and freedom from endocarditis.</p><p><strong>Results: </strong> Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group (<i>p</i> = 0.002), related to baseline intergroup differences. At 10 years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8; <i>p</i> = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; <i>p</i> = 0.001). The porcine group displayed a higher rate of PPM.</p><p><strong>Conclusion: </strong> Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of Long-Term Performance of Porcine versus Pericardial Bioprostheses.\",\"authors\":\"Amedeo Anselmi, Morgan Daniel, Marie Aymami, Celine Chabanne, Sebastien Rosier, Julien Mancini, Jean Philippe Verhoye\",\"doi\":\"10.1055/a-2505-8447\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series (<i>n</i> = 3,983 cases).</p><p><strong>Methods: </strong> 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 structural valve deterioration (SVD) with both Kaplan-Meier and competing risk 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 nonstructural valve dysfunction (NSVD) and freedom from endocarditis.</p><p><strong>Results: </strong> Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group (<i>p</i> = 0.002), related to baseline intergroup differences. At 10 years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8; <i>p</i> = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; <i>p</i> = 0.001). The porcine group displayed a higher rate of PPM.</p><p><strong>Conclusion: </strong> Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.</p>\",\"PeriodicalId\":23057,\"journal\":{\"name\":\"Thoracic and Cardiovascular Surgeon\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-02-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Thoracic and Cardiovascular Surgeon\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2505-8447\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thoracic and Cardiovascular Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2505-8447","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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) are 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 structural valve deterioration (SVD) with both Kaplan-Meier and competing risk 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 nonstructural valve dysfunction (NSVD) and freedom from endocarditis.
Results: Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group (p = 0.002), related to baseline intergroup differences. At 10 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 risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; p = 0.001). The porcine group displayed a higher rate of PPM.
Conclusion: Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.
期刊介绍:
The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field.
Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.