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Cangut B, Schaff HV, Suri RM, Greason KL, Stulak JM, Lahr BD, Michelena HI, Daly RC, Dearani JA, Crestanello JA. Excess Reintervention With Mitroflow Prosthesis for Aortic Valve Replacement: Ten-Year Outcomes of a Randomized Trial. Ann Thorac Surg 2023; 115:949-956. [PMID: 36183748 DOI: 10.1016/j.athoracsur.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current bioprostheses are considered to have improved durability and better hemodynamic performance compared with previous designs, but there are limited comparative data on late outcomes. METHODS From 2009 through 2011, 300 adults with severe aortic valve stenosis undergoing aortic valve replacement (AVR) were randomly assigned to receive Edwards Magna, St Jude Epic, or Sorin Mitroflow bioprostheses (n = 100, n = 101, n = 99, respectively). Overall survival was analyzed using Kaplan-Meier and Cox proportional hazards methods, whereas competing risk analysis was used for all time-to-event outcomes. Serial echocardiographic data were fitted with longitudinal models stratified by implant valve size. RESULTS During median follow-up of 9.8 years (interquartile range, 8.7-10.2), 10-year survival was 50% for the Magna group, 42% for the Epic group, and 41% for the Mitroflow group (P = .415). Cumulative risk of stroke was 9% at 10 years, and rates were comparable for the three groups. Indexed aortic valve area and mean gradients were similar among the three groups receiving 19 mm and 21 mm valves, but in larger (23 mm or more) prostheses, gradients were lower (P < .001) and indexed aortic valve areas were higher in the Magna group (P < .001). The 10-year risk of endocarditis differed by group (P = .033), with higher incidence in the Mitroflow vs the Magna group (7% vs 0%, P = .019). Late risk of reinterventions in the Mitroflow group was 22%, compared with 0% in the Magna group (P < .001) and 5% in the Epic group (P = .008). CONCLUSIONS The Magna valve had the lowest gradients and largest indexed aortic valve area with larger implant sizes. The Mitroflow bioprosthesis is associated with an increased rate of reintervention and possible increased risk of infection compared with Magna and Epic valves.
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Affiliation(s)
- Busra Cangut
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Persson M, Glaser N, Nilsson J, Friberg Ö, Franco-Cereceda A, Sartipy U. Comparison of Long-term Performance of Bioprosthetic Aortic Valves in Sweden From 2003 to 2018. JAMA Netw Open 2022; 5:e220962. [PMID: 35254431 PMCID: PMC8902647 DOI: 10.1001/jamanetworkopen.2022.0962] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. OBJECTIVE To analyze the long-term rates of reintervention, all-cause mortality, and heart failure hospitalization associated with commonly used bioprosthetic aortic valves and to identify valve model groups with deviation in clinical performance. DESIGN, SETTING, AND PARTICIPANTS This population-based, nationwide cohort study included all adult patients who underwent surgical aortic valve replacement (with or without concomitant coronary artery bypass surgery or ascending aortic surgery) in Sweden between January 1, 2003, and December 31, 2018. Patients were identified from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Patients with concomitant valve surgery, previous cardiac surgery, and previous transcatheter valve replacement were excluded. Follow-up was complete for all participants. Data were analyzed from March 9, 2020, to October 12, 2021. EXPOSURES Primary surgical aortic valve replacement with the Perimount, Mosaic/Hancock, Biocor/Epic, Mitroflow/Crown, Soprano, and Trifecta valve models. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative incidence of reintervention, defined as a subsequent aortic valve operation or transcatheter valve replacement. Secondary outcomes were all-cause mortality and heart failure hospitalization. Regression standardization and flexible parametric survival models were used to account for intergroup differences. Mean follow-up time was 7.1 years, and maximum follow-up time was 16.0 years. RESULTS A total of 16 983 patients (mean [SD] age, 72.6 [8.5] years; 10 685 men [62.9%]) were included in the analysis. The Perimount valve model group had the lowest and the Mitroflow/Crown valve model group had the highest cumulative incidence of reintervention. The estimated cumulative incidence of reintervention at 10 years was 3.6% (95% CI, 3.1%-4.2%) in the Perimount valve model group and 12.2% (95% CI, 9.8%-15.1%) in the Mitroflow/Crown valve model group. The estimated incidence of reintervention at 10 years was 9.3% (95% CI, 7.3%-11.3%) in the Soprano valve model group. CONCLUSIONS AND RELEVANCE Results of this study showed that the Perimount valve was the most commonly used and had the lowest incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve had the highest rates. These findings highlight the need for clinical vigilance in patients who receive either a Soprano or Mitroflow/Crown aortic bioprosthesis.
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Affiliation(s)
- Michael Persson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Johan Nilsson
- Department of Translational Medicine, Cardiothoracic Surgery and Bioinformatics, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Woods RK. Commentary: Can Kicking and Rip Currents. Semin Thorac Cardiovasc Surg 2021; 33:1093-1094. [PMID: 34242752 DOI: 10.1053/j.semtcvs.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Lam KY, Timmermans N, Soliman-Hamad M. The Risk of Reintervention of the Mitroflow and Trifecta Bioprosthesis. Ann Thorac Surg 2021; 112:684-685. [PMID: 33631148 DOI: 10.1016/j.athoracsur.2020.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ka Yan Lam
- Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands.
| | - Naomi Timmermans
- Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Mohamed Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
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Nardi P, Bassano C, Ruvolo G. The Risk of Reintervention of the Trifecta Bioprosthesis. Ann Thorac Surg 2021; 112:683-684. [PMID: 33421393 DOI: 10.1016/j.athoracsur.2020.09.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Unit, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy.
| | - Carlo Bassano
- Cardiac Surgery Unit, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy
| | - Giovanni Ruvolo
- Cardiac Surgery Unit, Tor Vergata University Policlinic, Viale Oxford 81, 00133 Rome, Italy
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Russo M, Werner P, Kastner J, Andreas M. Aortic valve-in-valve implantation requiring valve fracturing via a subclavian access: new insights with a word of caution. J Cardiovasc Med (Hagerstown) 2019; 20:787-791. [PMID: 31449177 DOI: 10.2459/jcm.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Johannes Kastner
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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Schaefer AK, Andreas M, Werner P, Sassi CG, Haberl T, Kocher A, Laufer G, Russo M. Excessive Pannus Overgrowth on the Aortic Side of Trifecta Valve Causing Severe Regurgitation. Ann Thorac Surg 2019; 108:e87-e89. [DOI: 10.1016/j.athoracsur.2018.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/25/2022]
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Lazar HL. Aortic Root Enlargement—Is It a Safe and Effective Approach to Prevent Patient-Prosthesis Mismatch and Is It for Everyone? Can J Cardiol 2019; 35:707-709. [DOI: 10.1016/j.cjca.2019.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 02/16/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022] Open
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Axtell AL, Chang DC, Melnitchouk S, Jassar AS, Tolis G, Villavicencio MA, Sundt TM, D'Alessandro DA. Early structural valve deterioration and reoperation associated with the mitroflow aortic valve. J Card Surg 2018; 33:778-786. [DOI: 10.1111/jocs.13953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea L. Axtell
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
- Minehan Outcomes Fellow; Minehan Heart Center; Boston Massachusetts
| | - David C. Chang
- Codman Center for Clinical Effectiveness; Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Serguei Melnitchouk
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Arminder S. Jassar
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - George Tolis
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Mauricio A. Villavicencio
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Thoralf M. Sundt
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - David A. D'Alessandro
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
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Chiariello GA, Villa E, Messina A, Mangini SM, Rozzi M, Dalla Tomba M, Leonzi O, Troise G. Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy. Cardiol Res 2018; 9:133-135. [PMID: 29755634 PMCID: PMC5942246 DOI: 10.14740/cr666w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/08/2018] [Indexed: 11/11/2022] Open
Abstract
Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a challenging scenario. Because of the high risk for surgical reoperation and the presence of chronic aortic dissection originated from a calcified Kommerel diverticulum, we considered to perform a transapical valve-in-valve transcatheter aortic valve implantation (TAVI) procedure. Myocardial ischemia is a dreadful complication reported in valve-in-valve TAVI procedures, mainly in patients with degenerated Mitroflow aortic bioprostheses. Because of the narrow shape of Valsalva sinuses and the short distance between Mitroflow annulus and left coronary ostium, to overcome the risk of possible Mitroflow leaflets displacement during TAVI expansion thus overlapping coronary ostia, we performed a preventive angioplasty. Then, we implanted a bare metal stent on the left main protruding in the aortic root. At 3 years follow-up the patient was in good clinical conditions.
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Affiliation(s)
- Giovanni Alfonso Chiariello
- Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy.,Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | - Emmanuel Villa
- Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | | | - Stefano Marwan Mangini
- Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy.,Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | | | | | - Ornella Leonzi
- Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
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Ruvolo G, Pisano C, Balistreri CR, Maresi E, Triolo OF, Argano V, Bassano C, Vacirca SR, Nardi P, Orlandi A. Early structural degeneration of Mitroflow aortic valve: another issue in addition to the mismatch? J Thorac Dis 2018; 10:E270-E274. [PMID: 29850167 DOI: 10.21037/jtd.2018.03.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We reported two cases of early structural valve degeneration (SVD) with Mitroflow prosthesis in aortic position in patients above the age of 65 years. Microscopic aspects have been analysed to investigate the intrinsic mechanism of SVD. New techniques to improve the structure and the preservation of this prosthesis are needed in order to reduce potential dangerous early complications.
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Affiliation(s)
- Giovanni Ruvolo
- Cardiac Surgery Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - Carmela Rita Balistreri
- Department of Pathobiology and Medical and Forensic Biotechnologies, University of Palermo, Palermo, Italy
| | | | | | | | - Carlo Bassano
- Cardiac Surgery Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - Paolo Nardi
- Cardiac Surgery Unit, Tor Vergata University Hospital, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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