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Wang DD, Caranasos TG, O'Neill BP, Stack RS, O'Neill WW, Chitwood WR. Comparison of a new bioprosthetic mitral valve to other commercially available devices under controlled conditions in a porcine model. J Card Surg 2021; 36:4654-4662. [PMID: 34610175 PMCID: PMC9292040 DOI: 10.1111/jocs.16021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023]
Abstract
Background/Aim To evaluate three mitral bioprostheses (of comparable measured internal diameters) under controlled, stable, hemodynamic and surgical conditions by bench, echocardiographic, computerized tomography and autopsy comparisons pre‐ and postvalve implantation. Methods Fifteen similar‐sized Yorkshire pigs underwent preprocedural computerized tomography anatomic screening. Of these, 12 had consistent anatomic features and underwent implantation of a mitral bioprosthesis via thoracotomy on cardiopulmonary bypass (CPB). Four valves from each of three manufacturers were implanted in randomized fashion: 27‐mm Epic, 27‐mm Mosaic, and 25‐mm Mitris bioprostheses. After CPB, epicardial echocardiographic studies were performed to assess hemodynamic function and define any paravalvular leaks, followed by postoperative gated contrast computerized tomography. After euthanasia, animals underwent necropsy for anatomic evaluation. Results All 12 animals had successful valve implantation with no study deaths. Postoperative echocardiographic trans‐valve gradients varied among bioprosthesis manufacturers. The 25‐mm Mitris (5.1 ± 2.7)/(2.6 ± 1.3 torr) had the lowest peak/mean gradient and the 27‐mm Epic bioprosthesis had the highest (9.2 ± 3.7)/(4.6 ± 1.9 torr). Surgical valve opening area (SOA) varied with the 25‐mm Mitris having the largest SOA (2.4 ± 0.15 cm2) followed by the 27‐mm Mosaic (2.04 ± 0.23 cm2) and the 27‐mm Epic (1.8 ± 0.27 cm2) valve. Bench device orthogonal internal diameter measurements did not match manufacturer device size labeling: 25‐mm Mitris (23 × 23 mm), 27‐mm Mosaic (23 × 22 mm), 27‐mm Epic (21 × 21 mm). Conclusions Current advertisement/packaging of commercial surgical mitral valves is not uniform. This study demonstrates marked variations in hemodynamics, valve opening area and anatomic dimensions between similar sized mitral bioprostheses. These data suggest a critical need for standardization and close scientific evaluation of surgical mitral bioprostheses to ensure optimal clinical outcomes.
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Affiliation(s)
- Dee Dee Wang
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Thomas G Caranasos
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian P O'Neill
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Richard S Stack
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Department of Medicine, Duke University, Durham, North Carolina, USA
| | - William W O'Neill
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - W Randolph Chitwood
- Cardiovascular Masters Consortium, Durham, North Carolina, USA.,Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Shintani Y, Kono T, Zaima Y, Kikusaki S, Saku K, Tayama E. Hemodynamic and clinical performance of the 25-mm Medtronic Mosaic porcine bioprosthesis in the mitral position. J Artif Organs 2021; 25:34-41. [PMID: 34023940 DOI: 10.1007/s10047-021-01277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
The 25-mm Medtronic Mosaic porcine bioprosthesis (MB25) is the smallest bioprosthesis that has been approved for use in the mitral position in Japan. Various studies have reported satisfactory hemodynamic performance and good long-term outcomes of the Medtronic Mosaic porcine bioprosthesis. However, the hemodynamic and clinical performances of the MB25 in the mitral position remain unknown. This study aimed to evaluate the hemodynamic and clinical performance of the MB25 in mitral valve replacement (MVR). Twenty patients who underwent MVR using the MB25 between February 2013 and April 2018 were studied. We evaluated the hemodynamic performance of the MB25, cardiac chamber size, cardiac function, and systolic pulmonary artery pressure (PAP) using echocardiography during follow-up. The study outcomes were major adverse cardiac events (MACEs) and all-cause mortality. Sixteen patients (80%) had a patient prosthesis mismatch defined as an index effective orifice area of ≤ 1.2 cm2/m2. The left atrial dimension was significantly reduced after surgery (p = 0.0282). The mean pressure gradients (MPG) in the mitral position were 5.5 ± 1.7 mmHg at discharge and 4.2 ± 1.3 mmHg at 1 year postoperatively. The MPG in the mitral position significantly decreased during the follow-up period (p = 0.0489). Systolic PAP significantly improved postoperatively. The 1-, 3-, and 5-year survival rates were 87, 79, and 70%, respectively. No cardiac death occurred. There were no MACEs or reports of structural valve degeneration during the follow-up period. The hemodynamic and clinical performances of the MB25 in the mitral position were satisfactory as the smallest biological mitral valve. The MB25 is a reasonable option for MVR to reduce the surgical difficulty in high-risk patients with an advanced age, a small body size or MAC and when recurrent MVR or complex procedures are performed.
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Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yusuke Shintani
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Satoshi Kikusaki
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
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