Mid-term hemodynamic and structural valve outcomes of bovine pericardial and porcine bioprostheses after surgical aortic valve replacement

Purpose Comparative longitudinal data on bovine and porcine bioprostheses after surgical aortic valve replacement (SAVR) remain limited, particularly in Japanese patients with small aortic annuli. We evaluated mid-term hemodynamic performance and structural valve outcomes using Valve Academic Research Consortium-3 (VARC-3) criteria. Methods We retrospectively reviewed 351 consecutive patients who underwent SAVR with conventional stented bioprostheses between 2012 and 2024. Patients receiving bovine (n = 180) or porcine (n = 171) bioprostheses were compared. Serial echocardiographic parameters and VARC-3-defined structural valve deterioration (SVD) were assessed. Propensity-score matching generated 62 matched pairs. Results In the matched cohort, the bovine group demonstrated lower mean transvalvular gradients at 1 year than the porcine group (11.7 ± 4.6 vs. 14.1 ± 5.2 mmHg, P = 0.004), and this difference persisted throughout follow-up. Overall survival was comparable between groups. Freedom from moderate SVD at 10 years did not differ significantly between groups (98.6% vs. 91.5%, P = 0.108). Subgroup analysis of 19-mm and 21-mm prostheses demonstrated comparable hemodynamic and valve-related outcomes. In the exploratory multivariable analysis, smaller prosthesis size was associated with SVD. Conclusion Both bovine and porcine bioprostheses demonstrated acceptable mid-term outcomes after SAVR. Bovine bioprostheses were associated with lower postoperative transvalvular gradients, whereas survival and severe valve-related events remained comparable between groups. Structural valve outcomes should be interpreted cautiously because of the limited number of events. Further studies with larger cohorts and longer follow-up are warranted to optimize prosthesis selection, particularly in patients requiring small surgical bioprostheses.