Late survival after aortic valve replacement with the perimount versus the mosaic bioprosthesis

Abstract

Background: The objective was to compare late survival after aortic valve replacement (AVR) with a Carpentier-Edwards Perimount (Edwards Lifesciences, Irvine, CA) versus a Mosaic bioprosthesis (Medtronic Inc, Minneapolis, MN). Secondary objectives were to compare early mortality, the rate of reoperation, and the effect of prosthesis-patient mismatch (PPM) on late survival.

Methods: The design was a population-based cohort study including all patients who underwent AVR with a Perimount or Mosaic bioprosthesis at our institution between 2002 and 2010. Baseline, operative characteristics and clinical outcomes were collected from patient charts and national registers. The primary outcome was all-cause mortality. We analyzed the unadjusted and multivariable adjusted association between valve type and late survival.

Results: In total, 1,219 patients received the Perimount (n=864) or the Mosaic (n=355) bioprosthesis. During a mean follow-up of 4.2 and 6.9 years, there were 193 and 177 deaths in the Perimount and Mosaic groups, respectively. The unadjusted 1-, 5-, and 8-year survival was 93%, 78%, and 63%, respectively, in the Perimount group and 92%, 80%, and 57%, respectively, in the Mosaic group (p=0.971).There was no significant association between valve choice and all-cause mortality in the multivariable analysis (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.65-1.11). Freedom from aortic valve reoperation was similar between the groups. No significant association was found between severe PPM and late mortality.

Conclusions: We found no significant difference in late survival after AVR with a Perimount bioprosthesis compared with a Mosaic bioprosthesis. Even though severe PPM was more common in the Mosaic group, it did not affect the late survival or the frequency of reoperation.