Clinical outcomes of porcine versus bovine bioprosthetic valves in different valve positions: a meta-analysis

Porcine and bovine bioprosthetic valves (porBHV and boBHV) are commonly used in surgical valve replacement, yet their durability across implant positions remains uncertain. This systematic review and meta-analysis compared survival, structural valve degeneration (SVD), and reoperation between porBHV and boBHV, stratified by implant position. We searched Medline, Embase, and Web of Science for cohort studies reporting odds ratios (ORs) with 95% confidence intervals (CIs) for mortality, SVD, and reoperation. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random-effects meta-analysis was used to pool ORs for clinical outcomes. Included bioprosthetic heart valves (BHVs) were classified into Generation 0, 1, or 2 according to anti-calcification treatment. Thirty-one studies (1988–2023) involving 65 783 patients (porBHV: 24 312; boBHV: 36 546) were included. In mitral valve replacement (MVR), porBHV was associated with lower mortality (OR 1.43, 95% CI 1.05–1.95, P = 0.02). Among Generation 2 valves in the mitral position, porBHV also showed lower rates of SVD than boBHV (OR 2.00, 95% CI 1.11–3.58; P = 0.02). In aortic valve replacement (AVR), porBHV showed higher SVD (OR 0.55, 95% CI: 0.35–0.87, P = 0.01) and reoperation rates (OR 0.69, 95% CI 0.50–0.95, P = 0.02). No significant differences were found in the pulmonary or unspecified positions. porBHV may be preferred in MVR because of better survival. boBHV showed lower SVD and reoperation rates in AVR overall; this apparent advantage may reflect differences in valve generation rather than intrinsic tissue superiority. Prosthesis selection should consider both implant position and valve generation.