Key result
Epic mitral bioprosthesis is linked to higher 5-year survival at ~74% versus other biological valves.
Why the study?
Long-term outcome data on biological mitral valve prostheses are needed as increasingly younger patients undergo biological mitral valve replacement.
Do different biological mitral valve prostheses have differing long-term survival and reoperation rates in patients undergoing biological mitral valve replacement?
Cohort (n=1,277)
No
Do different biological mitral valve prostheses have differing long-term survival and reoperation rates in patients undergoing biological mitral valve replacement?
Absolute Event Rate: 74.4% vs 65.8%
p-value: p=0.03
Five-year survival following biological mitral valve replacement varies by prosthesis type, with the Epic valve showing higher initial survival, though 15-year reoperation rates remain similar across other valve types.
Background Biological mitral valve replacement (bMVR) remains an established procedure in patients not suitable for mitral valve repair or lifelong anticoagulation. As increasingly younger patients are undergoing bMVR, long-term outcome data on biological prostheses are needed. Methods This retrospective, single-center study analyzed survival, reoperation, and echocardiographic data after primary bMVR (2001 - 2020) using multinomial propensity score weighting (PSW). Results The cohort (N = 1,277) received the following prostheses: Epic® (n = 299; 23.4%), Hancock® (n = 534; 41.8%), Mosaic® (n = 191; 14.9%), Perimount® (n = 253; 19.8%). Median age was 70.9 years (IQR, 58.5; 75.6) and 50.7% were female. Median follow-up time was 5.0 years (IQR: 1.1, 10.5). The number of concomitant procedures was balanced after PSW (standardized mean difference (SMD) = 0.051). Five-year survival was highest in the Epic group (74.4% ± 6.0% standard error [SE] vs. Hancock: 65.8% ± 2.0%, p=0.03; vs. Mosaic: 51.19% ± 5.0%, p=0.001; vs. Perimount: 62.8% ± 4.0%, p=0.009). Fifteen-year survival was comparable except for Hancock vs. Mosaic (p = 0.049) (Hancock: 32.3% ± 5.0%, Mosaic 20.3% ± 5.0%, Perimount: 18.3% ± 5.0%). Reoperation data (n = 566, 44.3%) were comparable after 15 years (Hancock: 10.0% [2.2% - 26.0%]; Mosaic: 17.0% [3.7% - 38.0%]; Perimount: 4.80% [0.85% - 14.00%]; p=0.60). Conclusions Five-year survival appeared highest in the Epic group, but long-term data are missing. Fifteen-year reoperation rates were comparable between Hancock, Mosaic and Perimount.
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Büchner et al. (2026) conducted a cohort in Mitral valve disease requiring replacement (n=1,277). Epic biological mitral valve prosthesis vs. Hancock, Mosaic, or Perimount prostheses was evaluated on Five-year survival (p=0.03). The Epic biological mitral valve prosthesis was associated with higher 5-year survival (74.4%) compared to Hancock (65.8%, p=0.03), Mosaic (51.2%, p=0.001), and Perimount (62.8%, p=0.009).
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