Exercise hemodynamics of bovine versus porcine bioprostheses: A prospective randomized comparison of the Mosaic and Perimount aortic valves

Department of Cardiovascular Surgery, German Heart Center Munich, Lazarettstrasse 36, 80636 Munich, Germany.
Journal of Thoracic and Cardiovascular Surgery (Impact Factor: 4.17). 06/2005; 129(5):1056-63. DOI: 10.1016/j.jtcvs.2004.08.028
Source: PubMed

ABSTRACT This prospective randomized study compares a porcine with a bovine bioprosthesis in the aortic position with regard to hemodynamic performance during exercise.
Between August of 2000 and December of 2002, 136 patients underwent aortic valve replacement with the porcine Medtronic Mosaic (n = 66) or the bovine Carpentier-Edwards Perimount (n = 70) bioprosthesis. Transthoracic echocardiography was performed to assess hemodynamic and dimensional data preoperatively and 10 months postoperatively; the latter follow-up included stress echocardiography with treadmill exercise.
At rest and during exercise (25 and 50 W), there was a significant difference in mean pressure gradient between the bovine and the porcine valves with labeled sizes 21 and 23, with superiority of the Perimount prosthesis. There was no difference in effective orifice area and incidence of patient-prosthesis mismatch among all sizes. The left ventricular mass index decreased significantly within 10 months postoperatively in the size 23 bovine group and the size 25 porcine group.
Our data show a significant superiority of pressure gradients for the bovine bioprosthesis, especially with small valve sizes, when compared with the porcine device, which is more distinctive during exercise.

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Available from: R. Bauernschmitt, May 23, 2014
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    • "As other articles presented early haemodynamic data, only their 1-year data were selected for inclusion in the analysis. The Deutsches Herzzentrum Munchen presented data from their hospital registry as well as an RCT during the same study period (2000–04) [22] [24]. The registry data may have contained some patients from the RCT; however, as the registry data study only contained patients with small annulus (≤23 mm) implantation, overall patient duplication would be small. "
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    ABSTRACT: Data comparing the haemodynamic performance of stented pericardial and porcine aortic valves are conflicting. Hence, we performed a systematic review and meta-analysis comparing the early haemodynamic parameters of stented pericardial and porcine valves in patients undergoing isolated aortic valve replacement. Medline, EMBASE and Web of Science were queried for English language original publications from 2000 to 2013. Studies comparing porcine (PoV) and pericardial (PeV) with regard to their haemodynamic parameters were included in this review. Continuous data were pooled using the mean difference (MD) or the standardized mean difference (SMD). A random-effect inverse weighted analysis was conducted; a P-value <0.05 is considered statistically significant. Results are presented with 95% confidence intervals. Thirteen studies (1265 PeV patients and 871 PoV patients) were included in this analysis. The pooled transvalvular mean gradient was lower for PeV [MD −4.6 (−6.45 to −2.77) mmHg; P < 0.01]. Limiting this analysis to small valves (19 and 21 mm; eight studies; 714 patients) revealed that the PeV gradients were significantly lower [MD −4.5 (−5.7 to −3.2); P = 0.001]. The corresponding effective orifice area of PeV was significantly larger than PoV [SMD 0.42 (0.15–0.69); P < 0.01]. A sensitivity analysis comprising only randomized controlled trials did not significantly alter results. When compared with porcine valves, stented pericardial aortic valves have lower mean transvalvular gradients early after implant. Even pericardial valves in smaller sizes (19 and 21 mm) have a better haemodynamic profile when compared with their counterparts.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2014; 47(1). DOI:10.1093/ejcts/ezu272 · 3.30 Impact Factor
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    ABSTRACT: a Abstract We compared the hemodynamic performance of the Edwards Perimount Magna (EPM) and the Medtronic Mosaic (MM) bioprostheses according to the patient aortic annulus diameter (AAD). Eighty-six patients undergoing aortic valve replacement were prospectively assigned to receive either an EPM-valve (ns43) or an MM-bioprosthesis (ns43). Randomization was performed after measuring the AAD and patients were grouped according to their AAD: -22 mm (ns12) ,2 2-23 mm (ns31) and )23 mm (ns43). Echocardiographic assessment was performed one year postoperatively. The mean AAD (EPM 23.9"2.1 mm vs. MM 23.6"2.3 mm) and mean valve size implanted (EPM 22.6"2.1 mm vs. MM 23.3"2.1 mm) were comparable in both groups. The EPM-group showed significantly lower mean gradient (EPM 10.2"3.2 mmHg vs. MM 17.1"8.2 mmHg) and larger effective orifice area (EOA )( EPM 1.99"0.4 cm vs. MM 1.69"0.4 cm , P-0.0001). 22
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