Key result
Mitral Epic xenografts linked to ~120% higher endocarditis reoperation risk vs aortic valve replacement.
Why the study?
The study aimed to evaluate midterm results after stented porcine xenograft implantation with Linx anticalcification treatment in elderly patients undergoing valve replacement.
Cohort (n=3,825)
No
Odds Ratio: 2.2 (95% CI 1.29–3.7)
p-value: p=0.003
Implantation of the Epic stented porcine xenograft in elderly patients provides acceptable midterm survival and freedom from structural valve disease reoperation across aortic, mitral, and double valve replacements.
Supports Epic xenograft use in elderly valve patients; leaves open durability beyond midterm and need for randomized comparisons.
BACKGROUND: The aim of this study was to evaluate the results after stented porcine xenograft implantation (Epic, SJM, St Paul, MN) with Linx anticalcification treatment in elderly patients at our high-volume tertiary care center. METHODS: A total of 3825 patients undergoing aortic (AVR = 2441), mitral (MVR = 892), or double valve (DVR = 492) replacement between 11/2001 and 12/2017 with Epic xenografts were evaluated. Outcomes were assessed by reviewing the prospectively acquired hospital database results, and regular annual follow-up information was acquired from questionnaires or telephone interviews. RESULTS: For patients undergoing AVR, MVR, DVR, age at surgery were 76.4 ± 6, 71.2 ± 9, 72.9 ± 8 years; active endocarditis was an indication for valve surgery in 4.5%, 20.7%, 19.7%; and the predicted median (interquartile range [IQR]) mortality risk (EuroSCORE II) was 5.2% (3.1%-9.4%), 7.5% (3.9%-16.2%), 9.9% (6.0%-19.6%), respectively. Median follow-up was 3.04 (IQR: 0.18-5.21). Thirty-day survival was 91.2% ± 0.6%, 87.6% ± 0.1.1%, 84.7% ± 1.6%; and 10-year survival was 56.7% ± 1.0%, 59.4% ± 2.5%, 50.45% ± 3.1%, respectively. Patients who underwent MVR versus AVR were at significant increased risk for reoperation for endocarditis (adjusted odds ratio; 2.2, 95% confidence interval; 1.29-3.7; P = .003). There was no significant difference in all-cause mortality at midterm in AVR vs MVR in the matched cohort (P = .85). CONCLUSIONS: Implantation of the Epic stented porcine xenograft is associated with acceptable survival and freedom from valve-related complications or reoperation due to structural valve disease at midterm follow-up.
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Jawad et al. (2020) conducted a cohort in Aortic, mitral, or double valve replacement (n=3,825). Mitral valve replacement (MVR) with Epic xenograft vs. Aortic valve replacement (AVR) with Epic xenograft was evaluated on Reoperation for endocarditis (OR 2.2, 95% CI 1.29-3.7, p=0.003). Mitral valve replacement with the Epic porcine xenograft was associated with a significantly increased risk of reoperation for endocarditis compared to aortic valve replacement (OR 2.2; 95% CI 1.29-3.7; P=0.003).
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