From the Guidelines
Bioprosthetic heart valves are primarily sourced from pigs (porcine valves) and cows (bovine valves). The use of these animal tissues is due to their close resemblance to human heart valves in structure and function 1. Porcine valves are made from actual pig heart valves that are chemically treated and mounted on a frame, while bovine valves are typically constructed using tissue from the pericardium (the sac surrounding a cow's heart) 1. Some key points to consider when choosing between bioprosthetic and mechanical valves include:
- The patient's age, with bioprosthetic valves often preferred for older patients (typically over 65) due to the lack of need for lifelong anticoagulation therapy 1
- The potential need for and risks associated with valve reintervention, as bioprosthetic valves have a limited lifespan of approximately 10-15 years before potentially requiring replacement 1
- The choice between porcine and bovine valves, which depends on specific patient factors and surgeon preference, as each has slightly different hemodynamic properties 1 It is essential to consider these factors and engage in a shared decision-making process with the patient to determine the most suitable type of valve for their individual needs 1. The most recent guidelines recommend a bioprosthetic valve for patients of any age for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired 1. Additionally, for patients over 65 years of age who require aortic valve replacement, a bioprosthesis is recommended over a mechanical valve 1.
From the Research
Bioprosthetic Valve Sources
The sources of bioprosthetic valves are primarily animals, with the two most common being:
- Bovine (cow)
- Porcine (pig)
Comparison of Bovine and Porcine Bioprosthetic Valves
Studies have compared the outcomes of bovine and porcine bioprosthetic valves, including:
- A study published in 2020 2 found that porcine bioprosthetic valves had better outcomes than bovine bioprosthetic valves in terms of freedom from reoperation and structural valve deterioration.
- A study published in 2015 3 found no difference in long-term survival or need for reoperation between bovine and porcine bioprosthetic valves.
- A study published in 2021 4 found no difference in long-term clinical outcomes, including structural valve deterioration, between bovine and porcine bioprosthetic valves.
- A systematic review and meta-analysis published in 2019 5 found no difference in all-cause mortality between patients who received bovine or porcine bioprosthetic valves.
- A study published in 2022 6 found no difference in short- and long-term outcomes, including mortality and freedom from reintervention, between bovine and porcine bioprosthetic valves.
Key Findings
Key findings from these studies include:
- Both bovine and porcine bioprosthetic valves are effective and safe for use in valve replacement surgery.
- The choice of valve type may not significantly impact long-term outcomes, including survival and freedom from reintervention.
- Further research is needed to fully understand the differences between bovine and porcine bioprosthetic valves and to inform clinical decision-making.