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Ann Thorac Surg 2001;71:S311-S314
© 2001 The Society of Thoracic Surgeons

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Bioprosthetic valves and conduits: new developments

Pericardial and porcine stentless aortic valves: are they hemodynamically different?

^a Department of Cardiac Surgery, Oxford Heart Centre, Oxford Radcliffe Hospitals, Oxford, United Kingdom

Address reprint requests to Dr Jin, Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
e-mail: x.y.jin{at}btinternet.com

Presented at the VIII International Symposium on Cardiac Bioprostheses, Cancun, Mexico, Nov 3–5, 2000.

Background. We sought to compare the early hemodynamic performance of pericardial stentless aortic valves with that of well-established porcine stentless aortic prostheses.

Methods. A total of 169 patients (97 men and 72 women, aged 73 ± 6 years) undergoing aortic valve replacement received either a pericardial (Pericarbon, Sorin Biomedica, Saluggia, Italy; n = 89) or a porcine (Freestyle, Medtronic, n = 80) stentless aortic valve. Aortic valve hemodynamics and root dynamism were assessed by Doppler echocardiography at discharge and 12 months after implantation.

Results. Clinical demographic data, valve size (24.0 ± 1.9 vs 24.6 ± 2.3 mm), and body surface area (1.85 ± 0.19 vs 1.80 ± 0.19 m²) did not differ between porcine and pericardial valves (both p > 0.05). The 1-year postoperative mean valve pressure gradient (4.2 ± 2.6 vs 3.7 ± 2.6 mm Hg), effective orifice area (2.2 ± 0.8 vs 2.2 ± 0.8 cm²), and left ventricular ejection fraction (62 ± 13 vs 63 ± 13, %) also did not differ (all p > 0.05). However, at discharge, systolic increase in aortic sinus diameter was significantly greater in pericardial valves than in porcine ones (7.7 ± 5.7 vs 4.9% ± 4.2%, p < 0.01). Furthermore, pericardial valves had a greater slope of effective orifice area–systolic aortic flow relationship (0.89 ± 0.07 vs 0.70 ± 0.06, cm²/100 mL/s, p < 0.01).

Conclusions. Nonprosthetic thin-walled pericardial valves appear to offer better aortic root dynamism and more efficient hemodynamics than those of porcine valves immediately after implant. At 1-year follow-up, however, both types of stentless valves provide equally excellent hemodynamics. The clinical choice between the two will depend on their long-term durability.

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