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BACKGROUND: Debate continues regarding the superiority of porcine vs pericardial bioprostheses, and data relevant to this comparison are scant. This study compared late survival and structural valve deterioration of porcine and pericardial mitral valve prostheses. METHODS: Adults undergoing mitral valve replacement with 1 first-generation porcine valve model and 1 pericardial valve line were reviewed from a prospectively maintained institutional database between 1976 and 2020. Multivariable regression and Cox proportional hazards analysis were used to compare late outcomes. RESULTS: Of 1162 consecutive patients, 612 (53%) received porcine valves and 550 (47%) received pericardial valves. At 10 years, patient survival (porcine, 36% ± 2%; pericardial, 38% ± 3%; P = .5) and cumulative incidence of mitral valve structural deterioration (porcine, 18% ± 2%; pericardial, 19% ± 3%; P = .3) were similar. The structural failure mode was more likely severe mitral stenosis in pericardial valves (35 of 50 [70%] vs 38 of 106 [36%]; P < .001), and it was more likely severe mitral regurgitation in porcine valves (80 of 106 [75%] vs 19 of 50 [38%]; P < .0001). After adjustment, structural deterioration was associated with younger patient age (P < .001) but not valve type. At 10 years, porcine valves demonstrated a higher cumulative incidence of mitral reoperation (19% ± 2% vs 9% ± 2%; P < .001) and reoperation for structural deterioration (15% ± 1% vs 6% ± 2%; P = .007). CONCLUSIONS: This study demonstrated similar rates of 10-year survival and structural deterioration with porcine and pericardial bioprostheses in mitral valve replacement. The study suggests a lack of major improvement in durability of mitral bioprosthetic valves over time. The failure mode may have a greater influence on surgeon decision making regarding valve choice.
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BACKGROUND: Debate persists regarding the outcomes of leaflet resection (RESECT) versus chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the leaflet resection versus chordal replacement techniques for degenerative mitral regurgitation. METHODS: 1066 consecutive patients receiving mitral repair for degenerative regurgitation using RESECT versus CHORD techniques were evaluated from a prospectively maintained database. Propensity score matching was used to compare outcomes in RESECT versus CHORD repairs. RESULTS: CHORD patients had later operative dates, more flail leaflet, and more anterior leaflet disease. With switch to predominant CHORD technique in 2010, the percent repair for all degenerative valves improved significantly from 83% to 91% (P=0.002). 467 patients were matched for baseline characteristics. CHORD patients had larger rings (34mm v 32mm, P<0.001) and more use of an Alfieri stitch (66% v 22%, P< 0.001) in matched patients. 10-year survival was similar for matched patients (RESECT vs CHORD: 86±3% v 84±4%, P=0.5). RESECT patients had a lower 10-year cumulative incidence of mitral reoperation (RESECT vs CHORD: 1±1% v 8±3%, P=0.002), and severe mitral regurgitation (RESECT vs CHORD: 1±1% v 9±5%, P=0.05) compared to matched CHORD patients. Late ejection fraction and mitral gradient were not different between two groups in matched patients, respectively (P=0.9 and P=0.2, respectively). CONCLUSIONS: The use of CHORD technique for degenerative mitral regurgitation increased the repair rates, but CHORD technique had slightly lower repair durability at 10-years compared to RESECT technique. These results could be related to more complex pathology in CHORD group.
RESUMO
Objective: We developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged septal wall. Here, we compare outcomes of patients with post-MI VSD repaired using patch only or hybrid patch/SOD. Methods: Patients undergoing post-MI VSD repair at our institution from 2013 to 2022 who received patch alone or patch/SOD repair were analyzed. Primary outcome was survival to hospital discharge. Clinical outcomes and echocardiograms were also analyzed. Results: Over a 9-year period, 24 patients had post-MI VSD repair at our institution with either hybrid patch/SOD (n = 10) or patch only repair (n = 14). VSD size was 18 ± 5.8 mm for patch/SOD and 17 ± 4.6 mm for patch only. In the patch/SOD repair cohort, average size of SOD implant was 23.6 ± 5.6 mm. Mild left ventricular dysfunction was present prerepair and was unchanged postrepair in both groups; however, moderate-to-severe right ventricular (RV) dysfunction was common in both groups before repair. RV function worsened or persisted as severe in 10% of hybrid versus 54% of patch-only patients postrepair. Tricuspid annular systolic excursion and RV:left ventricle diameter ratio, quantitative metrics of RV function, improved after patch/SOD repair. No intraoperative mortality occurred in either group. Postoperative renal, hepatic, and respiratory failure requiring tracheostomy was common in both groups. Survival to hospital discharge in both cohorts was 70%. Conclusions: Post-MI VSD repair with patch/SOD has comparable short-term outcomes with patch alone. Addition of a SOD to patch repair provides a scaffold that may enhance the repair of post-MI VSD with patch exclusion.