Pericardial and porcine stentless aortic valves: Are they hemodynamically different?

Background. We sought to compare the early hemodynamic performance of pericardial stentless aortic valves with that of well-established porcine stentless aortic prostheses. Methods. A total of 169 patients (97 men and 72 women, aged 73 ± 6 years) undergoing aortic valve replacement received either a pericardial (Pericarbon, Sorin Biomedica, Saluggia, Italy; n = 89) or a porcine (Freestyle, Medtronic, n = 80) stentless aortic valve. Aortic valve hemodynamics and root dynamism were assessed by Doppler echocardiography at discharge and 12 months after implantation. Results. Clinical demographic data, valve size (24.0 ± 1.9 vs 24.6 ± 2.3 mm), and body surface area (1.85 ± 0.19 vs 1.80 ± 0.19 m2) did not differ between porcine and pericardial valves (both p > 0.05). The 1-year postoperative mean valve pressure gradient (4.2 ± 2.6 vs 3.7 ± 2.6 mm Hg), effective orifice area (2.2 ± 0.8 vs 2.2 ± 0.8 cm2), and left ventricular ejection fraction (62 ± 13 vs 63 ± 13, %) also did not differ (all p > 0.05). However, at discharge, systolic increase in aortic sinus diameter was significantly greater in pericardial valves than in porcine ones (7.7 ± 5.7 vs 4.9% ± 4.2%, p < 0.01). Furthermore, pericardial valves had a greater slope of effective orifice area-systolic aortic flow relationship (0.89 ± 0.07 vs 0.70 ± 0.06, cm2/100 mL/s, p < 0.01). Conclusions. Nonprosthetic thin-walled pericardial valves appear to offer better aortic root dynamism and more efficient hemodynamics than those of porcine valves immediately after implant. At 1-year follow-up, however, both types of stentless valves provide equally excellent hemodynamics. The clinical choice between the two will depend on their long-term durability. © 2001 by The Society of Thoracic Surgeons