Durability of porcine and pericardial prostheses in tricuspid valve replacement

JTCVS open Pub Date : 2024-10-01 DOI:10.1016/j.xjon.2024.06.017

Brittany A. Zwischenberger MD, MHSc , Carmelo Milano MD , John Haney MD , Jeffrey G. Gaca MD , Jacob Schroder MD , Keith Carr BS , Donald D. Glower MD

{"title":"Durability of porcine and pericardial prostheses in tricuspid valve replacement","authors":"Brittany A. Zwischenberger MD, MHSc , Carmelo Milano MD , John Haney MD , Jeffrey G. Gaca MD , Jacob Schroder MD , Keith Carr BS , Donald D. Glower MD","doi":"10.1016/j.xjon.2024.06.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Biologic valves dominate tricuspid valve replacement, yet data on different valve types are lacking. We compare the survival and durability of porcine and pericardial tricuspid prostheses.</div></div><div><h3>Methods</h3><div>A retrospective review of consecutive patients undergoing tricuspid valve replacement with porcine (N = 542) or pericardial (N = 144) prostheses between 1975 and 2022 was performed using a prospectively maintained institutional database. Concurrent procedures were included. Cox proportional hazards and logistic regression were performed.</div></div><div><h3>Results</h3><div>Patients who received the porcine prosthesis, compared with pericardial, were younger (56 ± 17 years vs 63 ± 15 years) and more likely to present urgently (55% porcine, 44% pericardial); however, there were no differences in redo status or concomitant operations. Ten-year survival was not significantly different between the porcine and pericardial groups (35% ± 3% vs 28% ± 4%, respectively, <em>P</em> = .2). The 10-year cumulative incidence of structural valve deterioration (porcine 9% ± 2%, pericardial 11% ± 3%, <em>P</em> = .8), reoperation for structural valve deterioration (porcine 5% ± 1%, pericardial 4% ± 2%, <em>P</em> = .06), and severe regurgitation (porcine 4% ± 1%, pericardial 5% ± 2%, <em>P</em> = .7) were not significantly different between groups. The failure mode was similar, with no difference in severe stenosis (porcine 32/47 [68%], pericardial 11/16 [69%], <em>P</em> = .9) or severe regurgitation (porcine 18/47 [38%], pericardial 7/16 [44%], <em>P</em> = .7). On regression analysis, valve type was not associated with survival (<em>P</em> = .6). Valve type was not associated with structural valve deterioration (<em>P</em> = .1) or reoperation for structural valve deterioration (<em>P</em> = .9).</div></div><div><h3>Conclusions</h3><div>In our series, there were no differences in survival or durability between porcine and pericardial valves. In most patients undergoing tricuspid valve replacement, the choice of porcine versus pericardial prosthesis is unlikely to affect clinical outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"21 ","pages":"Pages 78-87"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624001773","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Biologic valves dominate tricuspid valve replacement, yet data on different valve types are lacking. We compare the survival and durability of porcine and pericardial tricuspid prostheses.

Methods

A retrospective review of consecutive patients undergoing tricuspid valve replacement with porcine (N = 542) or pericardial (N = 144) prostheses between 1975 and 2022 was performed using a prospectively maintained institutional database. Concurrent procedures were included. Cox proportional hazards and logistic regression were performed.

Results

Patients who received the porcine prosthesis, compared with pericardial, were younger (56 ± 17 years vs 63 ± 15 years) and more likely to present urgently (55% porcine, 44% pericardial); however, there were no differences in redo status or concomitant operations. Ten-year survival was not significantly different between the porcine and pericardial groups (35% ± 3% vs 28% ± 4%, respectively, P = .2). The 10-year cumulative incidence of structural valve deterioration (porcine 9% ± 2%, pericardial 11% ± 3%, P = .8), reoperation for structural valve deterioration (porcine 5% ± 1%, pericardial 4% ± 2%, P = .06), and severe regurgitation (porcine 4% ± 1%, pericardial 5% ± 2%, P = .7) were not significantly different between groups. The failure mode was similar, with no difference in severe stenosis (porcine 32/47 [68%], pericardial 11/16 [69%], P = .9) or severe regurgitation (porcine 18/47 [38%], pericardial 7/16 [44%], P = .7). On regression analysis, valve type was not associated with survival (P = .6). Valve type was not associated with structural valve deterioration (P = .1) or reoperation for structural valve deterioration (P = .9).

Conclusions

In our series, there were no differences in survival or durability between porcine and pericardial valves. In most patients undergoing tricuspid valve replacement, the choice of porcine versus pericardial prosthesis is unlikely to affect clinical outcomes.

查看原文本刊更多论文

猪和心包假体在三尖瓣置换术中的耐用性

目的生物瓣膜在三尖瓣置换术中占主导地位，但缺乏有关不同瓣膜类型的数据。我们比较了猪三尖瓣人工瓣膜和心包三尖瓣人工瓣膜的存活率和耐久性。方法使用前瞻性维护的机构数据库，对 1975 年至 2022 年间接受猪（542 例）或心包（144 例）人工瓣膜三尖瓣置换术的连续患者进行回顾性研究。同时进行的手术也包括在内。结果与心包假体相比，接受猪假体的患者更年轻（56 ± 17 岁 vs 63 ± 15 岁），更有可能急诊（猪假体占 55%，心包假体占 44%）；但两者在重做状态或并发手术方面没有差异。猪肝组和心包组的十年存活率无明显差异（分别为 35% ± 3% vs 28% ± 4%，P = .2）。结构性瓣膜恶化（猪瓣 9% ± 2%，心包 11% ± 3%，P = .8）、结构性瓣膜恶化再次手术（猪瓣 5% ± 1%，心包 4% ± 2%，P = .06）和严重反流（猪瓣 4% ± 1%，心包 5% ± 2%，P = .7）的 10 年累积发生率在各组间无显著差异。失败模式相似，严重狭窄（猪瓣 32/47 [68%]，心包瓣 11/16 [69%]，P = .9）或严重反流（猪瓣 18/47 [38%]，心包瓣 7/16 [44%]，P = .7）无差异。回归分析显示，瓣膜类型与存活率无关（P = .6）。结论在我们的系列研究中，猪瓣膜和心包瓣膜在存活率和耐用性方面没有差异。在大多数接受三尖瓣置换术的患者中，选择猪人工瓣膜还是心包人工瓣膜不太可能影响临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量