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Tong Q, Cai J, Wang Z, Sun Y, Liang X, Xu Q, Mahamoud OA, Qian Y, Qian Z. Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309844. [PMID: 38279610 DOI: 10.1002/smll.202309844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/10/2023] [Indexed: 01/28/2024]
Abstract
Valvular heart disease (VHD) has become a burden and a growing public health problem in humans, causing significant morbidity and mortality worldwide. An increasing number of patients with severe VHD need to undergo heart valve replacement surgery, and artificial heart valves are in high demand. However, allogeneic valves from donors are lacking and cannot meet clinical practice needs. A mechanical heart valve can activate the coagulation pathway after contact with blood after implantation in the cardiovascular system, leading to thrombosis. Therefore, bioprosthetic heart valves (BHVs) are still a promising way to solve this problem. However, there are still challenges in the use of BHVs. For example, their longevity is still unsatisfactory due to the defects, such as thrombosis, structural valve degeneration, calcification, insufficient re-endothelialization, and the inflammatory response. Therefore, strategies and methods are needed to effectively improve the biocompatibility and longevity of BHVs. This review describes the recent research advances in BHVs and strategies to improve their biocompatibility and longevity.
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Affiliation(s)
- Qi Tong
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Jie Cai
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhengjie Wang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yiren Sun
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Xuyue Liang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Qiyue Xu
- School of Basic Medicine, Mudanjiang Medical University, Mudanjiang, Heilongjiang, 157011, P. R. China
| | - Oumar Abdel Mahamoud
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
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Hemodynamic Performance and Outcomes of Mosaic Valve for Aortic Stenosis with Decreased Left Ventricular Function: Results from J-MOVE Study. ASAIO J 2019; 66:532-538. [PMID: 31335365 DOI: 10.1097/mat.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated impact of a small-sized Mosaic porcine bioprosthesis on hemodynamic performance and outcomes in patients with aortic stenosis (AS) and low left ventricular ejection fraction (LVEF) in a Japan multicenter cohort. Of 1,202 patients enrolled, 105 (8.7%) who had LVEF < 50% and AS underwent aortic valve replacement (AVR). Fifty-two patients received Mosaic porcine bioprosthesis ≤ 21 mm (S-AVR), and 53 received a bioprosthesis ≥ 23 mm (L-AVR). The median follow-up period was 3.1 [1.2, 5.1] years. At 5 years, LVEF significantly improved from median 41.2 [33.8, 45.9]% to 64.2 [49.8, 72.5]% in S-AVR (p < 0.001) and from median 43.2 [37.3, 46.8]% to 61.2 [47.2, 68.0]% in L-AVR (p < 0.001). The left ventricular mass index significantly decreased from median 158.4 [122.2, 194.9] to 110.0 [83.6, 129.4] gm/m in S-AVR (p < 0.001) and from median 169.8 [132.2, 203.6] to 109.6 [101.8, 132.4] gm/m in L-AVR (p < 0.001). There were no significant differences between S-AVR and L-AVR groups regarding freedom from cardiac death (93.1 ± 3.9% vs. 96.2 ± 3.8%; p = 0.119) and valve-related death (97.6 ± 2.4% vs. 100.0 ± 0.0%; p = 0.953). Clinical outcomes and improved hemodynamic performance were similar in both groups.
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Webb J, Parkin D, Tøndel K, Simitsis P, Roxburgh J, Chambers JB. A comparison of early redo surgery rates in Mosaic porcine and Perimount bovine pericardial valves. Eur J Cardiothorac Surg 2019; 54:724-728. [PMID: 29579171 DOI: 10.1093/ejcts/ezy113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/21/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare rates of redo surgery for the Medtronic Mosaic 305 A Porcine Prosthesis and the Carpentier-Edwards Perimount Pericardial Aortic Bioprosthesis 2900. METHODS This was a single-centre retrospective observational study. We included all 1018 patients who underwent aortic valve replacement with a Mosaic (n = 216) or Perimount (n = 809) bioprosthesis between October 2000 and August 2008. The total follow-up was 1508 patient-years for the Mosaic valve and 5813 for the Perimount valve. The maximal follow-up and interquartile range were 14.8 and 7.0 years for the Mosaic valve and 15.1 and 5.6 years for the Perimount valve, respectively. A propensity score-weighted version of the Cox model, Kaplan-Meier analysis and multivariate regression model was used. RESULTS Despite no statistical difference in the number of non-structural valve deterioration cases between valves, redo surgery occurred earlier in 10 (4.6%) Mosaic than for 17 (2.1%) Perimount valves (P = 0.02) and was required for structural valve deterioration in 5 (2.3%) Mosaic valves when compared with 7 (0.9%; P = 0.04) Perimount valves. Four of 5 Mosaic failures occurred before 5 years, whereas all Perimount failures occurred after 5 years. Redo surgery for non-structural valve deterioration occurred in 3 patients with Mosaic valves (1.4%) and no patients with Perimount valves. Surgery for the remaining patients with Perimount valves was due to infection or aortic disease. CONCLUSIONS Early redo surgery for structural valve degeneration was uncommon but occurred earlier for the Mosaic porcine than the Perimount bovine pericardial replacement aortic valve.
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Affiliation(s)
- Jessica Webb
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Denise Parkin
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kristin Tøndel
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Panagiotis Simitsis
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - James Roxburgh
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John B Chambers
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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Fatima B, Mohananey D, Khan FW, Jobanputra Y, Tummala R, Banerjee K, Krishnaswamy A, Mick S, Tuzcu EM, Blackstone E, Svensson L, Kapadia S. Durability Data for Bioprosthetic Surgical Aortic Valve. JAMA Cardiol 2019; 4:71-80. [DOI: 10.1001/jamacardio.2018.4045] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Benish Fatima
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fazal W. Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yash Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ramyashree Tummala
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene Blackstone
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Zibdeh O, Bugg I, Patel S, Twine G, Unsworth-White J. Randomized trial of the Carpentier–Edwards supra-annular prosthesis versus the Medtronic Mosaic aortic prosthesis: 10-year results†. Eur J Cardiothorac Surg 2018; 54:281-287. [PMID: 29401266 DOI: 10.1093/ejcts/ezx512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/02/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Omar Zibdeh
- Plymouth University, Peninsula School of Medicine, Plymouth, UK
| | - Ian Bugg
- Plymouth University, Peninsula School of Medicine, Plymouth, UK
| | - Shriyam Patel
- Plymouth University, Peninsula School of Medicine, Plymouth, UK
| | - Gina Twine
- South West Cardiothoracic Unit, Derriford Hospital, Plymouth, UK
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A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement. Ann Thorac Surg 2015; 99:17-25. [DOI: 10.1016/j.athoracsur.2014.09.022] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022]
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Andreas M, Wallner S, Ruetzler K, Wiedemann D, Ehrlich M, Heinze G, Binder T, Moritz A, Hiesmayr MJ, Kocher A, Laufer G. Comparable long-term results for porcine and pericardial prostheses after isolated aortic valve replacement. Eur J Cardiothorac Surg 2014; 48:557-61. [PMID: 25527170 PMCID: PMC4573977 DOI: 10.1093/ejcts/ezu466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Outcome of aortic valve replacement may be influenced by the choice of bioprosthesis. Pericardial heart valves are described to have a favourable haemodynamic profile compared with porcine valves, although the clinical notability of this finding is still controversially debated. Herein, we compared the long-term results of two commonly implanted bioprosthesis at a single centre. METHODS All consecutive patients undergoing isolated aortic valve replacement with either a Carpentier-Edwards Magna pericardial prosthesis or a Medtronic Mosaic porcine prosthesis between 2002 and 2008 were analysed regarding preoperative characteristics, short- and long-term survival, valve-related complications and echocardiographic findings. RESULTS The Medtronic Mosaic was implanted in 163 patients and the Carpentier-Edwards Magna in 295 patients. The sizes of implanted valves were 22.4 ± 1.5 mm for the Mosaic and 21.8 ± 1.8 mm for the Magna (P = 0.001). The long-term survival rate was 76 and 56% after 5 and 10 years for the Medtronic Mosaic, which was comparable with the Carpentier-Edwards Magna (77 and 57%; P = 0.92). Overall long-term survival was comparable with an age- and sex-matched Austrian general population for both groups. Valve-related adverse events were similar between groups. The postoperative mean transvalvular gradient was significantly increased in the Mosaic group (24 ± 9 mmHg vs 17 ± 7 mmHg; P < 0.001). CONCLUSIONS Both types of aortic bioprostheses offer excellent results after isolated aortic valve replacement. Despite relevant differences in gradients, long-term survival was comparable with the expected normal survival for both bioprostheses. Patients with a porcine heart valve had a higher postoperative transvalvular gradient.
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Affiliation(s)
- Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephanie Wallner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Kurt Ruetzler
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria Department of Anesthesiology, University Hospital Zuerich, Zuerich, Switzerland
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Information Management and Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anton Moritz
- Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Michael J Hiesmayr
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Glaser N, Franco-Cereceda A, Sartipy U. Late haemodynamic performance and survival after aortic valve replacement with the Mosaic bioprosthesis. Interact Cardiovasc Thorac Surg 2014; 19:756-62. [PMID: 25016530 DOI: 10.1093/icvts/ivu238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective was to evaluate the long-term haemodynamic performance of the Mosaic aortic bioprosthesis. Secondary objectives were to investigate the long-term survival, the rate of aortic valve reoperations, and the rate of prosthesis-patient mismatch and its effect on long-term survival. METHODS We included all patients who underwent aortic valve replacement with a Mosaic bioprosthesis at our institution between 2002 and 2008. Valve haemodynamics were assessed by transthoracic echocardiography as mean and peak pressure gradients. Patient characteristics and outcomes were collected from charts and national registers. RESULTS We included 355 patients and echocardiographic evaluation was performed at early follow-up in 340 patients (96%) and at late follow-up in 161 patients (45%). The mean follow-up time was 7.1 (maximum 11.7) years. The unadjusted survival at 1, 5 and 10 years was 92, 79 and 42%, respectively. At the early postoperative echocardiography, the peak pressure gradient was 39.9 mmHg (SD 14.4) and the mean pressure gradient was 21.1 mmHg (SD 7.7) and, on late echocardiography, the peak pressure gradient was 38.6 mmHg (SD 15.6) and the mean pressure gradient was 22.5 mmHg (SD 10.1). Moderate or severe prosthesis-patient mismatch was found in 250 (70%) and 49 patients (14%), respectively, but was not significantly associated with mortality in multivariable analyses. CONCLUSIONS We found that the Mosaic aortic bioprosthesis had acceptable clinical performance at late follow-up. However, a substantial proportion of patients had high transvalvular gradients or moderate or severe prosthesis-patient mismatch, although neither were significantly associated with long-term survival in our population.
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Affiliation(s)
- Natalie Glaser
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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