Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis

M Broadwin; N Ramkumar; D J Malenka; R D Quinn; C S Ross; F Hirashima; J D Klemperer; R S Kramer; G L Sardella; B Westbrook; A W Discipio; A Iribarne; M P Robich

doi:10.1155/2023/2111843

Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis

Cardiol Res Pract. 2023 Jun 30:2023:2111843. doi: 10.1155/2023/2111843. eCollection 2023.

Authors

M Broadwin¹, N Ramkumar², D J Malenka³, R D Quinn⁴, C S Ross³, F Hirashima⁵, J D Klemperer⁶, R S Kramer⁴, G L Sardella⁷, B Westbrook⁷, A W Discipio⁸, A Iribarne⁹, M P Robich¹⁰

Affiliations

¹ Department of Surgery, Lehigh Valley Health Network, 1200 South Ceder Crest Blvd, PA 18103, Allentown, USA.
² Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, NH 03755, Hanover, USA.
³ Department of Medicine, Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, NH 03756, Lebanon, USA.
⁴ Department of Surgery, Cardiovascular Institute, Maine Medical Center, 22 Bramhall Street, ME 04102, Portland, USA.
⁵ Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, 111 Colchester Avenue, VT 05401, Burlington, USA.
⁶ Northern Light Cardiology, Northern Light Eastern Maine Medical Center, 417 State Street, ME 04401, Bangor, USA.
⁷ Department of Surgery, Catholic Medical Center, 100 McGregor Street, NH 03102, Manchester, USA.
⁸ Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, NH 03756, Lebanon, USA.
⁹ Department of Surgery, Cardiothoracic Surgery, Staten Island University Hospital at Northwell Health, 475 Seaview Avenue, NY 10305, Staten Island, USA.
¹⁰ Johns Hopkins Hospital, Division of Cardiac Surgery, 1800 Orleans St, Zayed 7107, MD 21287, Baltimore, USA.

Abstract

Introduction: Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. Study Design. A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation.

Results: In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; p < 0.001), COPD (20% bovine vs. 27% porcine; p=0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; p=0.03), and coronary artery disease (65% bovine vs. 77% porcine; p < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00-1.37; p=050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23-1.32; p=0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81-1.17; p=0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20-1.47; p=0.225)).

Conclusions: In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching.