Comparison Of Bovine Pericardial Valve Versus Porcine Medtronic Mosaic Valve In Aortic Valve Replacement:A System Review And Clinical Study

Objectives: The optimal bioprosthesis for Aortic valve replacement(AVR)has not yet been developed.The meta-analysis was undertaken to review the results of published literatures of bovine and porcine valves in the aortic position.Retrospective study was carried out comparing the recent clinical manifestations between CEPM and MM.Methods: 1,The Embase,Pub Med and Cochrane Library databases were comprehensively searched.Seventeen studies comparied bovine valve Carpentier-Edwards Perimount(CEP),Perimount Magna(CEPM)with porcine valve Medtronic Mosaic(MM)were enrolled in this meta-analysis.Review Manager 5.3 for Windows was used to analyse the extracted data.2,we retrospected the base lines,perioperative data and test results of the cases which performed AVR of CEPM or MM,and followed up the survival 1 month after the surgery.Results: Meta-analysis: 1)CEP possessed lower Mean pressure gradient(MG)at rest(P<0.00001)and workloads(25 Watts: P<0.00001;50 Watts: P<0.00001;75 Watts: P<0.0001),lower Peak pressure gradient(PG)(P=0.01)and larger Effective orifice area(EOA)(P=0.009)than MM,but no significant difference was identified in terms of Effective orifice area index(EOAI),Left ventricular mass index(LVMI)and severe patient-prosthesis mismatch(SPPM)rate.2)Compared with MM,CEPM performed lower MG(P<0.0001)and PG(P<0.00001),bigger EOA(P<0.00001)and EOAI(P<0.001),lower LVMI(P=0.01)and lower SPPM rate(P<0.00001).3)In small valves replacement,CEPM had a larger EOAI than Mosaic Ultra in the aortic annulus diameter?23mm patient group(P<0.00001).Retrospective study: the CEPM group showed a lower MG(P=0.001)and PV(P=0.003)at 10 days after AVR in the case of no significant differences of the base lines and perioperative data.Left ventricular function: LVDD(P < 0.001)and LAD(P < 0.001)reduced than preoperative data,no significant change in EF(P=0.290)and PAP(P=0.051).The CEPM got lower LAD(P=0.025)than MM,no significant difference in EF(P=0.301),LVDD(P=0.459)and PAP(P=0.222).Conclusions: Meta-analysis: CEP performed better than MM in most of the hemodynamic indexes,but there were no significant differences in terms of EOAI,LVMI values and prolong durability such as long-term SVD,survival of patients and s PPM.The third-generation bovine valve(CEPM)exhibited comprehensive superiority in terms of hemodynamic performance and freedom from s PPM,the long-term durability is expected,however,the current lack of studies of prolong durability follow-up outcomes including SVD,postoperative survival of patients,freedom from reoperation and freedom from cardiovascular events.Retrospective study: the CEPM has obvious hemodynamic advantage compared with the MM at 10 days postoperatively,which reflected in lower MG and PV.The cardiac function of CEPM and MM groups was improved at 10 days postoperatively.Mortality was lower in 1 month after operation and was clinically reliable,but there was no significant difference between the two groups.The study found no early postoperative valve-related complications,but it still required long-term follow-up.