Abstract 11016: Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement - A Multi-Center Analysis

Introduction: Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in increased utilization of mitral bioprostheses. We examined long-term survival and risk of re-operation between patients having bovine vs porcine MVR. Methods: A retrospective analysis of MVR or MVR+CABG from 2001 - 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,308 patients undergoing MVR (811 bovine and 497 porcine). Baseline comorbidities were balanced using 1:1 propensity score matching with 432 patients in each group. . The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. Results: In the analytic cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; P<.001), COPD (21% bovine vs. 27% porcine; P=.01), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; P=.03) and coronary artery disease (65% bovine vs. 76% porcine; P<.001). In the overall cohort there was no difference in long-term survival (porcine HR 1.17 [95% CI 1.00-1.37; P=0.050]) or reoperation (porcine HR 0.56 [95% CI 0.23-1.32; P=0.19). In the propensity-matched cohort, the bovine valve patients were less likely to return to the OR for bleeding (6% vs. 9.3%; absolute standardized difference 0.12), but were more likely to have a stroke (3.7% vs. 1.9%; absolute standardized difference 0.11). There was no difference in in-hospital and 30-day mortality. After 1:1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 [95% CI 0.81-1.17; P=0.76]) or risk of reoperation (porcine HR 0.54 [95% CI 0.20-1.47; P=0.23). Conclusions: In this multicenter analysis of patients undergoing bioprosthetic MVR there was no difference in long-term survival, and risk of reoperation.