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Objective <p>The Epic porcine bioprosthesis is widely used for mitral valve replacement (MVR), but reports on its mid-to-long-term outcomes in Japanese patients are limited. We evaluated its clinical durability and identify predictors of mortality.</p> Methods <p>We retrospectively analyzed 119 patients who underwent MVR with the Epic valve between April 2013 and February 2025, excluding non-elective procedures. Primary endpoints were all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints included structural valve deterioration (SVD), redo MVR, and hemodynamic performance. Mortality and MACCE were assessed with a Kaplan–Meier analysis. Cumulative incidences of SVD and redo MVR were calculated using Gray’s test. Cox proportional hazards models were used to identify predictors of mortality.</p> Results <p>The mean age was 76.1 ± 6.2&#xa0;years, and 60.5% of the patients were female. Median follow-up was 3.0&#xa0;years [interquartile range, 1.0–5.8&#xa0;years]; maximum 10.4&#xa0;years. The rate of 7&#xa0;year freedom from all-cause mortality and MACCE was 74.3 and 42.4%, respectively. SVD occurred in three patients (2.5%) due to leaflet tearing, with a 7&#xa0;year cumulative incidence of 2.0%. The incidence of Redo MVR at 7&#xa0;years was 3.4%. The mean pressure gradient and peak velocity remained stable (3.8 ± 1.8&#xa0;mmHg and 1.7 ± 0.4&#xa0;m/s at 7&#xa0;years). Preoperative left ventricular ejection fraction (LVEF) &lt; 30% was the only independent predictor of mortality (HR: 3.16; 95% CI: 1.19–8.35; <i>p</i> = 0.021).</p> Conclusions <p>The Epic valve demonstrated favorable mid-to-long-term outcomes in the mitral position, with low SVD rates and stable hemodynamics. Preoperative LVEF &lt; 30% was associated with significantly increased mortality risk.</p>

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Mid-to-long-term outcomes, durability, and mortality predictors after mitral valve replacement with the Epic porcine bioprosthesis: a single-center Japanese experience

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Ryoma Ueda,
  • Senri Miwa,
  • Tatsuya Shinohara,
  • Shunji Kurokawa,
  • Kenji Yamamoto,
  • Sakae Enomoto

摘要

Objective

The Epic porcine bioprosthesis is widely used for mitral valve replacement (MVR), but reports on its mid-to-long-term outcomes in Japanese patients are limited. We evaluated its clinical durability and identify predictors of mortality.

Methods

We retrospectively analyzed 119 patients who underwent MVR with the Epic valve between April 2013 and February 2025, excluding non-elective procedures. Primary endpoints were all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints included structural valve deterioration (SVD), redo MVR, and hemodynamic performance. Mortality and MACCE were assessed with a Kaplan–Meier analysis. Cumulative incidences of SVD and redo MVR were calculated using Gray’s test. Cox proportional hazards models were used to identify predictors of mortality.

Results

The mean age was 76.1 ± 6.2 years, and 60.5% of the patients were female. Median follow-up was 3.0 years [interquartile range, 1.0–5.8 years]; maximum 10.4 years. The rate of 7 year freedom from all-cause mortality and MACCE was 74.3 and 42.4%, respectively. SVD occurred in three patients (2.5%) due to leaflet tearing, with a 7 year cumulative incidence of 2.0%. The incidence of Redo MVR at 7 years was 3.4%. The mean pressure gradient and peak velocity remained stable (3.8 ± 1.8 mmHg and 1.7 ± 0.4 m/s at 7 years). Preoperative left ventricular ejection fraction (LVEF) < 30% was the only independent predictor of mortality (HR: 3.16; 95% CI: 1.19–8.35; p = 0.021).

Conclusions

The Epic valve demonstrated favorable mid-to-long-term outcomes in the mitral position, with low SVD rates and stable hemodynamics. Preoperative LVEF < 30% was associated with significantly increased mortality risk.