Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study

Ayyaz Ali, Eric Lim, James Halstead, Hutan Ashrafian, Ziad Ali, Zain I Khalpey, Panagiotis Theodorou, Themis Chamageorgakis, Pankaj Kumar, Christopher Jackson, John Pepper

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background and aim of the study: Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series. Methods: Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines. Results: A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 ± 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2% and 95.7 versus 93.1%; p = 0.10), reoperation (99.2 versus 99.4% and 97.8 versus 96.7%; p = 0.45) and endocarditis (98.3 versus 99.4% and 97.4 versus 99.4%; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3% and 80.8 versus 73.7%, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p<0.0001), increasing age (p<0.001), increasing serum creatinine (p<0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005). Conclusion: The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.

Original languageEnglish (US)
Pages (from-to)430-435
Number of pages6
JournalJournal of Heart Valve Disease
Volume12
Issue number4
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

Aortic Valve
Allografts
Swine
Mortality
Ventricular Function
Endocarditis
Hypercholesterolemia
Reoperation
Telephone
Survivors
Creatinine
Multivariate Analysis
Joints
Hemodynamics
Odds Ratio
Demography
Guidelines
Survival
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ali, A., Lim, E., Halstead, J., Ashrafian, H., Ali, Z., Khalpey, Z. I., ... Pepper, J. (2003). Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study. Journal of Heart Valve Disease, 12(4), 430-435.

Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study. / Ali, Ayyaz; Lim, Eric; Halstead, James; Ashrafian, Hutan; Ali, Ziad; Khalpey, Zain I; Theodorou, Panagiotis; Chamageorgakis, Themis; Kumar, Pankaj; Jackson, Christopher; Pepper, John.

In: Journal of Heart Valve Disease, Vol. 12, No. 4, 07.2003, p. 430-435.

Research output: Contribution to journalArticle

Ali, A, Lim, E, Halstead, J, Ashrafian, H, Ali, Z, Khalpey, ZI, Theodorou, P, Chamageorgakis, T, Kumar, P, Jackson, C & Pepper, J 2003, 'Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study', Journal of Heart Valve Disease, vol. 12, no. 4, pp. 430-435.
Ali, Ayyaz ; Lim, Eric ; Halstead, James ; Ashrafian, Hutan ; Ali, Ziad ; Khalpey, Zain I ; Theodorou, Panagiotis ; Chamageorgakis, Themis ; Kumar, Pankaj ; Jackson, Christopher ; Pepper, John. / Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study. In: Journal of Heart Valve Disease. 2003 ; Vol. 12, No. 4. pp. 430-435.
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abstract = "Background and aim of the study: Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series. Methods: Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines. Results: A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 ± 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2{\%} and 95.7 versus 93.1{\%}; p = 0.10), reoperation (99.2 versus 99.4{\%} and 97.8 versus 96.7{\%}; p = 0.45) and endocarditis (98.3 versus 99.4{\%} and 97.4 versus 99.4{\%}; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3{\%} and 80.8 versus 73.7{\%}, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p<0.0001), increasing age (p<0.001), increasing serum creatinine (p<0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005). Conclusion: The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.",
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T1 - Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study

AU - Ali, Ayyaz

AU - Lim, Eric

AU - Halstead, James

AU - Ashrafian, Hutan

AU - Ali, Ziad

AU - Khalpey, Zain I

AU - Theodorou, Panagiotis

AU - Chamageorgakis, Themis

AU - Kumar, Pankaj

AU - Jackson, Christopher

AU - Pepper, John

PY - 2003/7

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N2 - Background and aim of the study: Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series. Methods: Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines. Results: A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 ± 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2% and 95.7 versus 93.1%; p = 0.10), reoperation (99.2 versus 99.4% and 97.8 versus 96.7%; p = 0.45) and endocarditis (98.3 versus 99.4% and 97.4 versus 99.4%; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3% and 80.8 versus 73.7%, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p<0.0001), increasing age (p<0.001), increasing serum creatinine (p<0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005). Conclusion: The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.

AB - Background and aim of the study: Stentless porcine valves in the aortic position exhibit similar excellent hemodynamic performance to homografts, but have the advantage of availability. Their performance was compared over a 10-year period in a single-surgeon and single-institution series. Methods: Demographic, operative and mortality data were obtained retrospectively. Survivors were interviewed by telephone according to a defined protocol. Definitions and analyses were in accordance with joint STS/AATS guidelines. Results: A total of 408 stentless porcine and homograft aortic valve replacements (AVR) was performed between 1991 and 2001. Five patients were excluded due to incomplete data, in addition to 82 patients who underwent AVR with a free-standing root replacement technique. Hence, 321 patients (217 males, 104 females; mean age 67 ± 12 years) had a subcoronary implant. The median time to follow up was 4.9 years (range: 2.9-6.6 years). No differences were noted between homograft and stentless porcine valves in one- and five-year freedom from structural valve deterioration (99.1 versus 97.2% and 95.7 versus 93.1%; p = 0.10), reoperation (99.2 versus 99.4% and 97.8 versus 96.7%; p = 0.45) and endocarditis (98.3 versus 99.4% and 97.4 versus 99.4%; p = 0.14). Overall one- and five-year survival comparing homograft to stentless porcine valve was 90.4 versus 92.3% and 80.8 versus 73.7%, respectively; p = 0.23. Independent predictors of mortality on multivariate analysis were: ventricular function (p<0.0001), increasing age (p<0.001), increasing serum creatinine (p<0.001) and concomitant coronary surgery (p = 0.05). Treated hypercholesterolemia was independently protective against mortality, with an odds ratio of 0.26 (CI 0.10 to 0.66; p = 0.005). Conclusion: The porcine stentless valve, when implanted in the subcoronary position, is an excellent alternative to the homograft and shows excellent clinical performance and durability at mid term.

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