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Ntinopoulos V, Biefer HRC, Dushaj S, Rings L, Fleckenstein P, Dzemali O, Haeussler A. Prosthesis-Patient Mismatch after Aortic Valve Replacement with the Mosaic Ultra Bioprosthesis. Thorac Cardiovasc Surg 2024; 72:197-204. [PMID: 37031679 DOI: 10.1055/s-0043-1768033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Several studies have reported high rates of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) with the Mosaic prosthesis. This work assesses the incidence of PPM after AVR with a modified version of the Mosaic prosthesis, the Mosaic Ultra. METHODS We performed a retrospective analysis of the data of 532 patients who underwent AVR with implantation of the Mosaic Ultra prosthesis in the period 2007-2016 in our institution. Patients were classified according to their indexed effective orifice area (EOAi) to severe (EOAi < 0.65 cm2/m2), moderate (EOAi 0.65-0.85 cm2/m2), and absent/mild PPM (EOAi > 0.85 cm2/m2). In-hospital postoperative outcomes and the impact of PPM on mean transvalvular pressure gradient after stratification by prosthesis size were assessed. RESULTS Overall, 3 (0.6%) patients had severe, 92 (17.3%) moderate, and 437 (82.1%) absent/mild PPM. There was a significant difference in PPM proportions (moderate/severe vs absent/mild PPM) across different prosthesis sizes overall (p < 0.0001), observing gradually increasing rates of PPM with decreasing prosthesis sizes. Patients with moderate/severe PPM had higher mean transvalvular pressure gradients (19 [13-25] vs 13 [10-17] mm Hg, p < 0.0001) than patients with absent/mild PPM. There was a significant difference in mean transvalvular pressure gradient between the different aortic valve prosthesis sizes overall (p < 0.0001), observing gradually increasing gradients with decreasing prosthesis sizes. CONCLUSION Patients undergoing AVR with the smaller sized (19, 21, and 23 mm) Mosaic Ultra aortic valve prostheses exhibit a higher risk for moderate/severe PPM and higher mean aortic transvalvular pressure gradients than patients receiving the larger sized (25, 27, and 29 mm) prostheses.
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Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | | | - Stak Dushaj
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Laura Rings
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Philine Fleckenstein
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
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Hori D, Yamamoto T, Kimura N, Yamaguchi A. Left ventricular remodeling and long-term outcomes of aortic stenosis patients receiving 19 mm Mosaic. J Artif Organs 2024; 27:32-40. [PMID: 36991242 DOI: 10.1007/s10047-023-01390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
Mosaic valve shows higher pressure gradient after aortic valve replacement compared to other same size labeled prostheses in postoperative echocardiogram. The purpose of this study was to evaluate the mid-term echocardiogram findings and long-term clinical outcomes of patients receiving a 19 mm Mosaic. Forty-six aortic stenosis patients receiving 19 mm Mosaic and 112 patients receiving either 19 mm Magna or Inspiris, who underwent mid-term follow-up echocardiogram were included in the study. Mid-term hemodynamic measurements evaluated by trans-thoracic echocardiogram and long-term outcomes were compared. Patients receiving Mosaic were significantly older (Mosaic: 76 ± 5.1 years vs. Magna/Inspiris: 74 ± 5.5 years, p = 0.046) and had smaller body surface area (Mosaic: 1.40 ± 0.114m2 vs. Magna/Inspiris: 1.48 ± 0.143m2, p < 0.001). There were no significant differences in comorbidities and medications. Post-operative echocardiogram performed at 1 week after the surgery showed higher maximum pressure gradient in patients receiving Mosaic (Mosaic: 38 ± 13.5 mmHg vs. Magna/Inspiris: 31 ± 10.7 mmHg, p = 0.002). Furthermore, mid-term echocardiogram follow-up performed at median duration of 53 ± 14.9 months after the surgery continuously showed higher maximum pressure gradient in patients receiving Mosaic (Mosaic: 45 ± 15.6 mmHg vs. Magna/Inspiris: 32 ± 13.0 mmHg, p < 0.001). However, there were no significant difference in changes in left ventricular mass from baseline in both groups. Kaplan-Meyer curve also showed no difference in long-term mortality and major adverse cardiac and cerebrovascular event between the two groups. Although the pressure gradient across the valve evaluated by echocardiogram was higher in 19 mm Mosaic compared to 19 mm Magna/Inspiris, there were no significant differences in left ventricular remodeling and long-term outcomes between the two groups.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan.
| | - Takahiro Yamamoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan
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AlBadri A, Joseph J, Patel V, Patel D, Koren O, Cheng W, Jilaihawi H, Makkar R. Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves. JACC Cardiovasc Interv 2023; 16:542-554. [PMID: 36922040 DOI: 10.1016/j.jcin.2023.01.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement is indicated in patients undergoing repeat intervention for degenerative aortic valve bioprostheses. Patients with internally stented valves (ie, Mitroflow and Trifecta) are at high risk for coronary artery obstruction during ViV procedures because of valve design, as the leaflets are mounted outside the valve stent. OBJECTIVES The aim of this study was to compare the hemodynamic and clinical outcomes of transcatheter aortic valve replacement within internally stented valves (ViV-IS) vs other surgical valves (ViV-OS). METHODS Baseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV-IS were retrospectively collected and compared with those of patients who underwent ViV-OS. RESULTS A total of 250 patients (65% men, median Society of Thoracic Surgeons score 4.4% [IQR: 2.2%-8.4%]) were included. Seventy-one patients (28%) underwent ViV-IS, and 179 (72%) patients underwent ViV-OS. Patients who underwent ViV-OS had better periprocedural hemodynamic status compared with those who underwent ViV-IS (median mean gradient 6 [IQR: 2-13] vs 12 [IQR: 6-16]; P < 0.001). This was not significantly different when both groups were matched on the basis of age, sex, and valve internal diameter size (median mean gradient: 18 [IQR: 13-25] for ViV-OS vs 18 [IQR: 11-24] for ViV-IS; P = 0.36). Coronary protection for potential occlusion was performed more in ViV-IS vs ViV-OS pr (79% vs 6%, respectively; P < 0.001). Patients who underwent ViV-IS had a higher risk for coronary occlusion, requiring stent deployment, compared with those who underwent ViV-OS (54% vs 3%, respectively; P < 0.001. There was no difference in mortality at 3 years between the 2 groups (P = 0.59). CONCLUSIONS Patients who underwent ViV-IS had a very high incidence of coronary compromise that can be safely and effectively treated. In the setting of a systematic coronary protection strategy, ViV-OS and ViV-IS provide similar mid-term outcome, and periprocedural hemodynamic status (following adjustment for age, sex, and true internal diameter).
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Affiliation(s)
- Ahmed AlBadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jubin Joseph
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Boehm J, Vitanova K, Prinzing A, Krane M, Lange R. Aortic valve neocuspidization using autologous pericardium compared to surgical aortic valve replacement. J Card Surg 2022; 37:3110-3116. [DOI: 10.1111/jocs.16800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Johannes Boehm
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Anatol Prinzing
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Markus Krane
- DZHK (German Center for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany
- Divison of Cardiac Surgery Yale School of Medicine New Haven Connecticut USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
- DZHK (German Center for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany
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Malvindi PG, Kattach H, Luthra S, Ohri S. Modes of failure of Trifecta aortic valve prosthesis. Interact Cardiovasc Thorac Surg 2022; 35:6554752. [PMID: 35348698 PMCID: PMC9297516 DOI: 10.1093/icvts/ivac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pietro Giorgio Malvindi
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Hassan Kattach
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
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Agnino A, Graniero A, Gerometta P, Giroletti L, Albano G, Roscitano C, Anselmi A. Less invasive aortic valve replacement using the trifecta bioprosthesis. SCAND CARDIOVASC J 2022; 56:79-84. [PMID: 35536053 DOI: 10.1080/14017431.2022.2071460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. The safety and effectiveness of the Trifecta GT bioprosthesis (introduced in 2016) in less invasive aortic valve replacement are scarcely investigated. Our aim was to evaluate the immediate and initial follow-up results of this device in the context of less invasive surgery. We discuss patient-specific strategies for the selection of the surgical approach. Methods. A retrospective review of 133 patients undergoing AVR with the Trifecta GT through three less invasive accesses (UMS, Upper ministernotomy; RMS, Reversed ministernotomy; RAMT, Right anterior minithoracotomy) was performed. In-hospital, follow-up and hemodynamic performance (PPM, Patient-prosthesis mismatch) data were collected. Results. Among patients, 79% received UMS, 11% RMS and 10% RAMT. Selection of approach was based on preoperative anatomical analysis (CT-scan) and planned concomitant procedures. There was no operative mortality, no valve-related adverse events. There were 36 concomitant procedures. No significant intergroup differences occurred in cardiopulmonary bypass, aortic clamp, mechanical ventilation time, ICU stay and average bleeding. There were two cases of moderate PPM (1.5%) and no instances of severe PPM; there were no significant (≥2/4) perivalvular leaks. Average mean gradient at discharge was 8 ± 3 mmHg. At follow-up (average: 2.5 ± 0.9 years, 100% complete, 315 patient years) there was no mortality and no valve-related adverse event. Hemodynamic performance was maintained at follow-up. Conclusions. The optimal device for less invasive AVR needs to be individualized, as well as the selection of the surgical approach. The use of the Trifecta GT bioprosthesis appears to be reproductible whatever less invasive approach is employed, with confirmed excellent hemodynamic performance.
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Affiliation(s)
- Alfonso Agnino
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Ascanio Graniero
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - Laura Giroletti
- Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.,Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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Durability and clinical experience using a bovine pericardial prosthetic aortic valve. J Thorac Cardiovasc Surg 2021; 161:1742-1749. [DOI: 10.1016/j.jtcvs.2019.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022]
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8
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Vaidya YP, Cavanaugh SM, Sandhu AA. Surgical aortic valve replacement in small aortic annulus. J Card Surg 2021; 36:2502-2509. [PMID: 33821514 DOI: 10.1111/jocs.15555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although aortic valve replacement (AVR) has been the standard of treatment for severe aortic stenosis, a small aortic annulus (SAA) poses significant challenges. Improvements in valve designs and evolution in surgical techniques have led to improved outcomes, however, the ideal prosthetic valve remains elusive. METHODS We performed a comprehensive literature review to discuss the surgical management of aortic stenosis, with a special focus on patients with SAA. RESULTS Stentless valves and root replacement techniques have been shown to overcome the hemodynamic challenges associated with conventional stented bioprostheses, but are technically challenging and require longer cross-clamp times. Sutureless and rapid deployment valves mitigate the long operative time while maintaining the hemodynamic advantages. The use of transcatheter AVR has emerged as another reasonable alternative and has shown promise among patients with SAA, however, long-term outcomes are awaited. CONCLUSION There is no consensus regarding the type of valve prosthesis or replacement technique among patients with SAA. Consideration of patient comorbidities and valvular anatomy is paramount in planning the optimal strategy for AVR. Further long-term clinical trials are necessary to assess outcomes and achieve progress toward the development of the ideal prosthesis.
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Affiliation(s)
- Yash P Vaidya
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Shaelyn M Cavanaugh
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Aqeel A Sandhu
- Department of Cardiothoracic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Takaseya T, Oryoji A, Takagi K, Fukuda T, Arinaga K, Hiromatsu S, Tayama E. Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis. Heart Vessels 2021; 36:1256-1263. [PMID: 33586008 PMCID: PMC8260398 DOI: 10.1007/s00380-021-01802-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/29/2021] [Indexed: 12/02/2022]
Abstract
Aortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.
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Affiliation(s)
- Tohru Takaseya
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan.
| | - Atsunobu Oryoji
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Tomofumi Fukuda
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Shinichi Hiromatsu
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
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Vriesendorp MD, de Lind van Wijngaarden RAF, Rao V, Moront MG, Patel HJ, Sarnowski E, Vatanpour S, Klautz RJM. An in vitro comparison of internally versus externally mounted leaflets in surgical aortic bioprostheses. Interact Cardiovasc Thorac Surg 2020; 30:417-423. [PMID: 31778161 DOI: 10.1093/icvts/ivz277] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To improve haemodynamic performance, design modifications of prosthetic valves have been proposed with each new generation of valves. These different designs also impact the amount of mechanical wear, because mechanical stresses are distributed differently. Because long-term evidence for new prosthetic valves is lacking, this in vitro study compared hydrodynamic performance and durability among 3 currently available bioprosthetic valves with internally (IMLV) or externally mounted leaflets (EMLV). METHODS Prostheses of the internally mounted Medtronic Avalus and Carpentier-Edwards Perimount Magna Ease valves were compared to prostheses of the externally mounted Abbott Trifecta valve. For each labelled size (e.g. 19, 21 and 23) of the 3 types, 3 valves underwent accelerated wear testing for up to 600 million cycles, corresponding to ∼15 years of simulated wear. The valves underwent hydrodynamic testing and visual inspection. RESULTS EMLV had the largest effective orifice area and lowest pressure gradient for each labelled size at baseline and 600 million cycles; the effective orifice area and the pressure gradient were equivalent for the 2 types of IMLV. Five of 9 EMLVs had at least 1 hole or tear in the leaflet tissue around the stent posts, which resulted in severe regurgitation at 500 million cycles in 2 cases. All IMLVs were intact at 600 million cycles with minimal tissue wear. CONCLUSIONS EMLV showed superior hydrodynamic performance but inferior mechanical durability compared to IMLV after 600 million cycles of testing. The primary failures were because of significant mechanical abrasion in the commissural region, which may warrant close monitoring of EMLV during long-term follow-up.
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Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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Fukuhara S, Shiomi S, Yang B, Kim K, Bolling SF, Haft J, Tang P, Pagani F, Prager RL, Chetcuti S, Grossman PM, Patel HJ, Deeb GM. Early Structural Valve Degeneration of Trifecta Bioprosthesis. Ann Thorac Surg 2020; 109:720-727. [DOI: 10.1016/j.athoracsur.2019.06.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/02/2019] [Accepted: 06/10/2019] [Indexed: 12/15/2022]
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12
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Manabe S, Koinoshita R, Hirayama D, Yuge N, Hirooka K. Hemodynamic performance and incidence of patient-prosthesis mismatch of small-sized Trifecta pericardial aortic valves. Gen Thorac Cardiovasc Surg 2020; 68:938-942. [PMID: 31894504 DOI: 10.1007/s11748-019-01284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Small-sized bioprosthetic valves are sometimes associated with suboptimal hemodynamic performance, leading to a patient-prosthesis mismatch. Trifecta pericardial valves are designed to improve hemodynamic performance. The purpose of this study was to investigate the hemodynamic properties of small-sized Trifecta valves and their efficacy in preventing a patient-prosthesis mismatch. METHODS This was a retrospective analysis of 108 patients undergoing surgical aortic valve replacement with a Trifecta valve of 23 mm or less in a single Japanese institution. The hemodynamic performance was evaluated with an echocardiography examination in all patients after surgery, and the development of a patient-prosthesis mismatch was judged with the measured in vivo indexed effective orifice area. RESULTS There was one early and seven late mortalities. There were no valve explants due to structural valve deterioration. Postoperative mean pressure gradients of 19-, 21-, and 23-mm valves were 15.1, 11.4, and 9.0 mmHg, respectively. The effective orifice area of 19-, 21-, and 23-mm valves was 1.41, 1.69, and 1.78 cm2, respectively. Patient-prosthesis mismatch occurred in 14 patients (1 severe and 13 moderate) and the incidence was 13.0% (15.4% in 19 mm, 18.0% in 21 mm, and 3.3% in 23 mm). CONCLUSIONS The small-sized Trifecta valves showed excellent hemodynamic performance and were associated with a low incidence rate of patient-prosthesis mismatch.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | - Ryoji Koinoshita
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Daiki Hirayama
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Norihisa Yuge
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kazunobu Hirooka
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
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13
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Commentary: Betting the trifecta: Gradient, prosthesis–patient mismatch, and durability. J Thorac Cardiovasc Surg 2019; 158:1040. [DOI: 10.1016/j.jtcvs.2018.11.012] [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: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
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