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Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S. Prosthesis-patient mismatch following aortic and mitral valves replacement – A comprehensive review. Prog Cardiovasc Dis 2022; 72:84-92. [PMID: 35235847 DOI: 10.1016/j.pcad.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulaziz Joury
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Antonio Duran
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Merrill Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Yvonne E Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen M Spindel
- Ochsner Clinical School, New Orleans, LA, United States of America; Division of Cardiothoracic Surgery, Ochsner Medical Center, New Orleans, LA, United States of America.
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
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2
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Fu B, Liu X, Wei R, Chen Q, Guo Z, Jiang N. Bovine pericardial versus porcine stented replacement mitral valves: early hemodynamic performance and clinical results of a randomized comparison of the Perimount and the Mosaic valves. J Thorac Dis 2021; 13:262-269. [PMID: 33569206 PMCID: PMC7867808 DOI: 10.21037/jtd-20-3274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare the hemodynamic and clinical outcomes following mitral valve replacement with the Perimount valve with those of the Mosaic valve. Methods A total of 145 consecutive patients with rheumatic heart valve disease who underwent single bioprosthetic mitral valve replacement were randomized to receive either the Perimount (n=72) valve or the Mosaic bioprosthesis (n=73). The mean age of patients was 72.1 years (range, 58-89 years) with a sex distribution of 55.2% female and 44.8% male. Patients underwent follow up transthoracic echocardiography at 3 months and 1 year postoperatively. We compared demographics, preoperative clinical data, operative data, hemodynamic profiles, and clinical outcomes. Results The cross-clamp time was similar, with 50.7±15.3 minutes for the Perimount and 50.7±21.8 minutes for the Mosaic bioprosthesis. The total bypass time was also similar, with 91.3±25.7 minutes for the Perimount and 87.8±25.6 minutes for the Mosaic valve. The peak and mean pressure gradients were lower in the Perimount group for all valve sizes and the difference was statistically significant at 1 year. The effective orifice area (EOA) was slightly larger in the Perimount valve (1.98±0.21 vs. 1.89±0.71 cm2, P=0.538) postoperatively, but there was no significant difference at 1 year. There were no differences in preoperative or postoperative left atrium diameter (LAD), left ventricular diastolic diameter (LVDD), left ventricular systolic diameter (LVSD), left ventricular ejection fraction (LVEF), pulmonary artery pressure (PAP). The mortality and major complications rate were similar between the two groups. Conclusions The Perimount prostheses is superior to the Mosaic prostheses after mitral valve replacement, achieving statistically significant lower gradients and larger EOA when compared on the basis of manufacturer-labeled valve sizes. Both valves appear to provide satisfactory clinical results.
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Affiliation(s)
- Bo Fu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Xiankun Liu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Runsheng Wei
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
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Kalogerakos PD, Kontopodis N, Ioannou CV, Kladou E, Chalkiadakis G, Athanasiou T, Lazopoulos G. Hemodynamics and reverse remodeling associated with Mosaic, Perimount and Trifecta aortic bioprostheses. Expert Rev Med Devices 2019; 16:743-751. [PMID: 31318302 DOI: 10.1080/17434440.2019.1642105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The implantation rate of aortic bioprostheses is increasing. Their durability has improved to some extent over the years and they allow for future transcatheter valve-in-valve deployment. In the lack of long term follow up, their hemodynamic profile, i.e. transvalvular mean pressure gradient and effective orifice area indexed, and the associated left ventricular reverse remodeling indexed are useful surrogates for clinical outcomes. Areas covered: A systematic review of the literature was conducted by searching Medline, Cochrane, Scielo, Embase databases, and grey literature until July 2018 for articles that perform comparisons among the three most popular aortic bioprostheses. Six randomized and 12 non-randomized studies were included with 565 patients receiving a Mosaic, 1334 a Perimount and 557 a Trifecta valve. These articles are heterogeneous but they allow the meta-analytic comparison of the abovementioned outcomes. Expert opinion: Compared to the Perimount valve, the Mosaic is hemodynamically inferior, while the Trifecta is superior. Despite these statistically significant differences, the left ventricular mass regression indexed, that is indicative of reverse remodeling, was comparable in all groups. All patients were similarly benefited. The predilection among these valves is fueled by their hemodynamic profile but not supported by the comparable reverse remodeling.
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Affiliation(s)
- Paris D Kalogerakos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Nikolaos Kontopodis
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Christos V Ioannou
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Eleni Kladou
- c Internal Medicine Department, University Hospital of Heraklion , Crete , Greece
| | - George Chalkiadakis
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Thanos Athanasiou
- d Faculty of Medicine, Department of Surgery and Cancer, Imperial College London , London , UK
| | - George Lazopoulos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
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Braathen B, Husebye T, Lunde IG, Tønnessen T. Trifecta has lower gradient and less prosthesis-patient mismatch than Mosaic Ultra in the aortic position: A prospective randomized study. J Thorac Cardiovasc Surg 2018; 158:1032-1039. [PMID: 30635187 DOI: 10.1016/j.jtcvs.2018.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE When aortic valve replacement is needed, a biological valve is usually implanted in patients older than age 60 to 65 years. A large valvular opening area is important to avoid prosthesis-patient mismatch and facilitate reverse left ventricular remodeling. The Trifecta biological valve (St Jude Medical, St Paul, Minn) is, because of its design, believed to reduce transvalvular gradient compared with other biological valves, especially in smaller annuli. Several retrospective studies have compared transvalvular gradients of implanted valves prostheses using the respective manufacturers given size and not the actual annulus size measured by a metric sizer. This makes comparison of the hemodynamic properties of different valve brands and sizes difficult. We therefore performed a prospective randomized study, using the same metric sizer to measure annulus size, and compared hemodynamic profiles of the Trifecta to our standard Mosaic Ultra biological valve (Medtronic, Minneapolis, Minn). METHODS Ninety elective patients with small to medium annulus diameter undergoing aortic valve replacement were randomized to either Trifecta or Mosaic Ultra. After native valve removal and decalcification, a Hegar-sizer was used to measure true annulus size. Then the largest possible valve of either brand was implanted according to the randomization protocol. Echocardiography was performed 6 months postoperatively. RESULTS Baseline parameters of the 2 cohorts were comparable. There were lower transvalvular gradients in the Trifecta compared with the Mosaic Ultra group for the given annulus sizes. Severe prosthesis-patient mismatch was present in 28% of patients in the Mosaic group and 3% of patients in the Trifecta group. CONCLUSIONS Trifecta showed lower transvalvular gradients and less severe prosthesis-patient mismatch compared with Mosaic Ultra for the given annulus sizes. ClinicalTrials.gov Protocol ID: 2011/2596/REK.
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Affiliation(s)
- Bjørn Braathen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway
| | - Trygve Husebye
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Ida G Lunde
- Institute for Experimental Medical Research and Center for Heart Failure Research, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Theis Tønnessen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway; University of Oslo, Oslo, Norway.
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Jamieson WRE, Germann E, Aupart MR, Neville PH, Marchand MA, Fradet GJ. 15-Year Comparison of Supra-Annular Porcine and PERIMOUNT Aortic Bioprostheses. Asian Cardiovasc Thorac Ann 2016; 14:200-5. [PMID: 16714695 DOI: 10.1177/021849230601400306] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The second-generation Carpentier-Edwards bioprostheses, the supra-annular porcine valve and the PERIMOUNT pericardial valve, have been evaluated longitudinally for several years. This study compared clinical performance over 15 years. Aortic valve replacement was performed with a supra-annular porcine valve in 1,823 patients (group 1) aged 19–89 years (mean, 68.9 ± 10.9 years) and with a PERIMOUNT pericardial bioprosthesis in 1,430 patients (group 2) aged 16–90 years (mean, 69.5 ± 10.4 years). The groups were similar except for concomitant coronary artery bypass in 43% of group 1 and 18% of group 2 ( p < 0.001). Overall survival at 15 years was 29.3% ± 1.5% for group 1 and 35.2% ± 3.1% for group 2 ( p = 0.0009). The actual freedom from valve-related mortality was 88.5% ± 0.9% for group 1 and 84.9% ± 1.7% for group 2. The actual freedom from structural valve deterioration at 15 years was similar overall, and for patients aged > 60 years, between the groups, but was dissimilar (group 2 > group 1) for age ≤ 60 years. The predictors of structural valve deterioration were valve type (group 1 > group 2), sex (male > female), age, and concomitant coronary artery bypass. Both bioprostheses provided satisfactory clinical performance at 15 years after aortic valve replacement.
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Affiliation(s)
- W R Eric Jamieson
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
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Dayan V, Soca G, Stanham R, Lorenzo A, Ferreiro A. Is patient–prosthesis mismatch a predictor of survival or a surrogate marker of co-morbidities in cardiac surgery? Int J Cardiol 2015; 190:389-92. [DOI: 10.1016/j.ijcard.2015.04.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/18/2015] [Indexed: 11/15/2022]
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Sharma V, Deo SV, Altarabsheh SE, Cho YH, Erwin PJ, Park SJ. Comparison of the early haemodynamics of stented pericardial and porcine aortic valves. Eur J Cardiothorac Surg 2015; 47:4-10. [PMID: 25123674 DOI: 10.1093/ejcts/ezu272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Data comparing the haemodynamic performance of stented pericardial and porcine aortic valves are conflicting. Hence, we performed a systematic review and meta-analysis comparing the early haemodynamic parameters of stented pericardial and porcine valves in patients undergoing isolated aortic valve replacement. Medline, EMBASE and Web of Science were queried for English language original publications from 2000 to 2013. Studies comparing porcine (PoV) and pericardial (PeV) with regard to their haemodynamic parameters were included in this review. Continuous data were pooled using the mean difference (MD) or the standardized mean difference (SMD). A random-effect inverse weighted analysis was conducted; a P-value<0.05 is considered statistically significant. Results are presented with 95% confidence intervals. Thirteen studies (1265 PeV patients and 871 PoV patients) were included in this analysis. The pooled transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77) mmHg; P<0.01]. Limiting this analysis to small valves (19 and 21 mm; eight studies; 714 patients) revealed that the PeV gradients were significantly lower [MD -4.5 (-5.7 to -3.2); P=0.001]. The corresponding effective orifice area of PeV was significantly larger than PoV [SMD 0.42 (0.15-0.69); P<0.01]. A sensitivity analysis comprising only randomized controlled trials did not significantly alter results. When compared with porcine valves, stented pericardial aortic valves have lower mean transvalvular gradients early after implant. Even pericardial valves in smaller sizes (19 and 21 mm) have a better haemodynamic profile when compared with their counterparts.
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Affiliation(s)
- Vikas Sharma
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Salil V Deo
- Adventist Wockhardt Heart Institute, Athawalines, Surat, India Division of Cardiovascular Surgery, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Yan Hyun Cho
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Soon J Park
- Division of Cardiovascular Surgery, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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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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Amorim P, Diab M, Färber G, Kirov H, Gonzales-Lopes D, Doenst T. Hämodynamische Ergebnisse nach Aortenklappenersatz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-014-1109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Diemert P, Seiffert M, Frerker C, Thielsen T, Kreidel F, Bader R, Schirmer J, Conradi L, Koschyk D, Schnabel R, Reichenspurner H, Blankenberg S, Kuck KH, Treede H, Schaefer U. Valve-in-valve implantation of a novel and small self-expandable transcatheter heart valve in degenerated small surgical bioprostheses: The Hamburg experience. Catheter Cardiovasc Interv 2014; 84:486-93. [DOI: 10.1002/ccd.25234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/26/2013] [Accepted: 09/24/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Patrick Diemert
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | | | - Thomas Thielsen
- Department of Cardiology; St. Georg Hospital; Hamburg Germany
| | - Felix Kreidel
- Department of Cardiology; St. Georg Hospital; Hamburg Germany
| | - Ralf Bader
- Department of Cardiothoracic Surgery; St. Georg Hospital; Hamburg Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Dietmar Koschyk
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Renate Schnabel
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Karl-Heinz Kuck
- Department of Cardiology; St. Georg Hospital; Hamburg Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Ulrich Schaefer
- Department of Cardiology; St. Georg Hospital; Hamburg Germany
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A look at recent improvements in the durability of tissue valves. Gen Thorac Cardiovasc Surg 2013; 61:182-90. [DOI: 10.1007/s11748-013-0202-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 10/27/2022]
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A prospective, randomized comparison of 3 contemporary bioprosthetic aortic valves: Should hemodynamic performance influence device selection? J Thorac Cardiovasc Surg 2012; 144:1387-95, 1398; discussion 1395-7. [DOI: 10.1016/j.jtcvs.2012.07.105] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 06/11/2012] [Accepted: 07/25/2012] [Indexed: 11/22/2022]
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Gurvitch R, Toggweiler S, Willson AB, Wijesinghe N, Cheung A, Wood DA, Ye J, Webb JG. Outcomes and complications of transcatheter aortic valve replacement using a balloon expandable valve according to the Valve Academic Research Consortium (VARC) guidelines. EUROINTERVENTION 2011; 7:41-8. [PMID: 21550902 DOI: 10.4244/eijv7i1a10] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS There is heterogeneity in the reporting of procedural outcomes and complications following transcatheter aortic valve replacement (TAVR). Recently, new definitions have been proposed by the Valve Academic Research Consortium (VARC) in an effort to standardise these outcomes and improve the quality of future clinical research. The aim of this study is to report the procedural outcomes and complication rates following TAVR in a large sequential patient cohort using a balloon expandable valve according to the new VARC definitions. METHODS AND RESULTS Three hundred and ten consecutive patients undergoing TAVR were assessed, including patients forming our early historical series at the infancy of TAVR. All complication rates were re-evaluated according to VARC definitions. Mean age was 82.2 ± 8.1 years and the Society of Thoracic Surgeons score was 9.4 ± 5.7%. Transfemoral 30-day mortality was 6.8% (3.8% in the second half of the cohort) and transapical 30-day mortality was 13.7% (9.4% in the second half of the cohort). Cardiovascular 30-day mortality was 7.4% and the composite safety endpoint at 30-days was 18.4%. Device success was 80% (post-procedural valve area ≤ 1.2 cm2 in 9.7%). Failure to deliver and deploy a valve occurred in only 3.5%, with 82% (nine cases) occurring in the first half of the experience. Of those who did not meet echocardiographic criteria for device success (valve area ≤ 1.2 cm2, transaortic gradient ≥ 20 mmHg or ≥ moderate aortic incompetence), 90% achieved a New York Heart Association class I/II. Life threatening bleeding complications occurred in 8.4%. In 7.7% of patients, red blood cell transfusions were given without evidence of overt bleeding. Major strokes occurred in 2.3% and acute kidney injury occurred in 6.5%. CONCLUSIONS The VARC consensus guidelines provide a standardised reporting framework for clinical endpoints and complications post TAVR. We report the first series to our knowledge of 30-day outcomes using these definitions utilising a balloon expandable valve system.
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Affiliation(s)
- Ronen Gurvitch
- Department of Cardiology and Cardiothoracic Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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The Mosaic porcine bioprosthesis: Role of age on clinical performance in aortic position. J Thorac Cardiovasc Surg 2011; 141:1440-8.e1. [DOI: 10.1016/j.jtcvs.2010.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 04/22/2010] [Accepted: 05/20/2010] [Indexed: 11/20/2022]
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15
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Hemodynamic performance of the Medtronic Mosaic and Perimount Magna aortic bioprostheses: five-year results of a prospectively randomized study. Eur J Cardiothorac Surg 2011; 39:844-52; discussion 852. [DOI: 10.1016/j.ejcts.2010.11.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/30/2010] [Accepted: 11/04/2010] [Indexed: 11/18/2022] Open
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Abstract
Prosthetic heart valve (PHV) dysfunction is a rare, but potentially life-threatening, complication. In clinical practice, PHV dysfunction poses a diagnostic dilemma. Echocardiography and fluoroscopy are the imaging techniques of choice and are routinely used in daily practice. However, these techniques sometimes fail to determine the specific cause of PHV dysfunction, which is crucial to the selection of the appropriate treatment strategy. Multidetector-row CT (MDCT) can be of additional value in diagnosing the specific cause of PHV dysfunction and provides valuable complimentary information for surgical planning in case of reoperation. Cardiac magnetic resonance imaging (CMR) has limited value in the evaluation of biological PHV dysfunction. In this Review, we discuss the use of established imaging modalities for the detection of left-sided mechanical and biological PHV dysfunction and discuss the complementary role of MDCT in this context.
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Moon D, Lee JW, Kim YS, Cho WC, Jung SH, Choo SJ, Chung CH. Midterm Results of Aortic Valve Replacement Using Tissue Valve. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dukhwan Moon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, The Army Armed Forces Hampyung Hospital
| | - Won-Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Suk-Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Cheol-Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, O'Rourke RA, Shah PM. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52:e1-142. [PMID: 18848134 DOI: 10.1016/j.jacc.2008.05.007] [Citation(s) in RCA: 1057] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bovine pericardial versus porcine stented replacement aortic valves: Early results of a randomized comparison of the Perimount and the Mosaic valves. J Thorac Cardiovasc Surg 2008; 136:1142-8. [DOI: 10.1016/j.jtcvs.2007.12.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 12/10/2007] [Accepted: 12/27/2007] [Indexed: 11/23/2022]
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523-661. [PMID: 18820172 DOI: 10.1161/circulationaha.108.190748] [Citation(s) in RCA: 802] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Riess FC, Bader R, Cramer E, Hansen L, Kleijnen B, Wahl G, Wallrath J, Winkel S, Bleese N. Hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years. Ann Thorac Surg 2007; 83:1310-8. [PMID: 17383332 DOI: 10.1016/j.athoracsur.2006.07.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Mosaic bioprosthesis (Medtronic, Minneapolis, MN) is a third-generation stented porcine bioprosthesis combining physiologic fixation and amino oleic acid antimineralization treatment to improve hemodynamic performance and durability. The findings of this single-center experience with this valve were evaluated to determine the clinical and hemodynamic performance. METHODS Between February 1994 and October 1999, we enrolled 255 patients with aortic valve replacement (AVR) with a mean age of 67 years (range, 23 to 82 years) and 47 patients with mitral valve replacement (MVR) with a mean age of 67 years (range, 41 to 84 years) in this post-United States Food and Drug Administration approval prospective and nonrandomized clinical trial. Patients were followed-up, including serial echocardiographic assessment, within 30 days, at 6 months, and annually thereafter. The cumulative follow-up was 1540 patient-years for AVR (mean, 6.1 years; maximum, 10 years) and 250 patient-years for MVR (mean, 5.4 years, maximum; 10 years). RESULTS Early mortality after AVR (<30 days) was 0.8%; late mortality per patient-year was 3.5%, including a valve-related/unexplained mortality of 1.1%. Early mortality after MVR (<30 days) was 0.0%; late mortality per patient-year was 2.8%, including a valve-related/unexplained mortality of 1.2%. Median postoperative gradient and effective orifice area for all valves after AVR were (early, n = 252; 5 years, n = 161; 9 years, n = 43) 13.7, 12.3, and 11.7 mm Hg and 1.9, 1.8, and 1.8 cm2 at early, 5 years, and 9 years, respectively. With MVR respective data were (early, n = 46; 5 years, n = 25; 7 years, n = 13) 4.6, 4.1, and 3.9 mm Hg and 1.8, 2.2, and 2.3 cm2. At 10 years, freedom from adverse events in the AVR group and MVR group was, respectively, thromboembolism, 86.6% +/- 6.6% and 86.3% +/- 9.8%; permanent neurologic event, 91.2% +/- 6.8% and 90.9% +/- 8.7%; valve thrombosis, 98.2% +/- 0.8% and 100%; structural valve deterioration, 87.1% +/- 6.7% and 100%. CONCLUSIONS Our midterm results demonstrate clinical safety and good performance of the Mosaic bioprosthesis. Continued follow-up will determine if this new design will provide increased durability.
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Jamieson WRE, Moffatt-Bruce SD, Skarsgard P, Hadi MA, Ye J, Fradet GJ, Abel JG, Janusz MT, Cheung A, Germann E. Early antithrombotic therapy for aortic valve bioprostheses: is there an indication for routine use? Ann Thorac Surg 2007; 83:549-56; discussion 556-7. [PMID: 17257986 DOI: 10.1016/j.athoracsur.2006.07.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Consensus reports over the past 10 years from the United States, Europe, United Kingdom, and Canada have not provided consistent guidelines for antithrombotic therapy of aortic valve bioprostheses for the three-month period after surgery. This study was conducted to determine if antithrombotic therapy was protective against TE with aortic bioprostheses 30 days or less after aortic valve replacement (AVR). METHODS From 1994 to 2000, 1,372 patients implanted with three currently marketed aortic bioprostheses, Medtronic Mosaic (Medtronic, Inc, Minneapolis, MN) (415 patients), Carpentier-Edwards SAV (462), and Carpentier-Edwards PERIMOUNT (495) (Edwards Lifesciences, Irvine, CA), with a mean age of greater than 70 years were evaluated. Patient populations were comparable, inclusive of concomitant coronary artery bypass grafting (CABG) for the overall populations and for patients greater than 70 years. RESULTS There were 37 thromboembolic (TE) events: major TE, 14; reversible ischemic neurologic deficit (RIND), 12; and minor TE, 11. There were 4 TE deaths. Multivariate (stepwise logistic regression) analysis revealed no predictive risk factors for overall TE. For the combination of major TE plus RIND there were two predictive risk factors with analysis of 12 risk variables: preoperative cerebrovascular accident (odds ratio [OR] 4.45, 95% confidence interval [CI] 1.17 to 16.87, p = 0.028); and concomitant CABG (OR 3.19, 95% CI 1.16 to 8.76, p = 0.025). Neither anticoagulant nor antiplatelet therapies gave significant protection. CONCLUSIONS There does not appear to be an indication for routine antithrombotic management. The study supports the potential use of antithrombotic therapy for comorbidities of preoperative cerebrovascular accident and concomitant CABG but not atrial fibrillation, left ventricular dysfunction, or elderly age greater than 70 years. Vascular burden and advanced age are likely contributing factors to these independent predictors. There may still be a need for, or at least consideration of, a randomized trial for AVR with bioprostheses.
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Affiliation(s)
- W R Eric Jamieson
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48:e1-148. [PMID: 16875962 DOI: 10.1016/j.jacc.2006.05.021] [Citation(s) in RCA: 1091] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bonow RO, Carabello BA, Kanu C, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 2006; 114:e84-231. [PMID: 16880336 DOI: 10.1161/circulationaha.106.176857] [Citation(s) in RCA: 1387] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Raja SG, Macarthur KJ, Pollock JC. Impact of Stentless Aortic Valves on Left Ventricular Function and Hypertrophy: Current Best Available Evidence. J Card Surg 2006; 21:313-9. [PMID: 16684073 DOI: 10.1111/j.1540-8191.2006.00240.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Past four decades have seen a gradual evolution in aortic valve replacement surgery. The ideal valve substitute should combine central flow, low transvalvular gradient, low thrombogenicity, durability, easy availability, resistance to infection, freedom from anticoagulation, and easy implantability. Although there are several types of valves available to replace the diseased aortic valve-autograft, allograft, xenograft, mechanical, and bioprosthetic valves-none is ideal. On one end of the spectrum is the pulmonary autograft, which comes closest to achieving these goals, but creates a double valve procedure for single valve disease, while on the other end are the mechanical valves and stented tissue valves, which allow easy "off the shelf" availability as well as easy implantability but are limited by the potential drawback of causing intrinsic obstruction to some extent because of the space occupied by the stent and sewing ring. Stentless xenograft aortic valves have been developed as a compromise between these ends of the valve spectrum. Stentless aortic valves have been reported to provide more physiologic hemodynamic behavior and cause more timely and thorough regression of ventricular hypertrophy. This review article attempts to evaluate current best available evidence from randomized controlled trials to assess the impact of stentless aortic valves on left ventricular function and hypertrophy.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Royal Hospital for Sick Children, Glasgow, UK.
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Totaro P, Degno N, Zaidi A, Youhana A, Argano V. Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance? J Thorac Cardiovasc Surg 2005; 130:1668-74. [PMID: 16308014 DOI: 10.1016/j.jtcvs.2005.07.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 06/10/2005] [Accepted: 07/07/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We designed this study to evaluate the early hemodynamic performance of the recently introduced Carpentier-Edwards PERIMOUNT Magna bioprosthesis (Edwards Lifesciences, Irvine, Calif) and compare it with those of the conventional Carpentier-Edwards PERIMOUNT stented bioprosthesis (Edwards Lifesciences) and Edwards Prima Plus porcine stentless bioprosthesis (Edwards Lifesciences). METHODS Sixty-three patients (>70 years old) were enrolled in this prospective, randomized study. At operation, once the annulus had been measured, the best size suitable was assessed for each of the three valves before random assignment. Transthoracic echocardiography was performed before discharge to evaluate early postoperative hemodynamic performances of the different valves implanted. RESULTS The best size suitable of Edwards Prima Plus (24.3 +/- 1.7 mm) was significantly superior to those of both the Carpentier-Edwards PERIMOUNT Magna (23.4 +/- 2.1 mm) and Carpentier-Edwards PERIMOUNT (22.4 +/- 1.8 mm). The best size suitable of the Carpentier-Edwards PERIMOUNT Magna, however, was significantly superior to that of the Carpentier-Edwards PERIMOUNT. Furthermore the best size suitable of the Carpentier-Edwards PERIMOUNT Magna was equal to the measured annulus in 55% of patients, as opposed to 25% for the Carpentier-Edwards PERIMOUNT (P < .001). Mean implanted labeled size of the Edwards Prima Plus was significantly higher than those of both the Carpentier-Edwards PERIMOUNT Magna and the Carpentier-Edwards PERIMOUNT (24.6 +/- 1.9 mm, 23.1 +/- 1.9 mm, and 22.5 +/- 1.8 mm, respectively). Early postoperative hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna, however, was superior to those of both the Edwards Prima Plus and the Carpentier-Edwards PERIMOUNT in both effective orifice area index (1.07 +/- 0.4 cm2/m2, 0.87 +/- 0.3 cm2/m2, and 0.80 +/- 0.2 cm2/m2, respectively) and mean peak gradient (20 +/- 6 mm Hg, 27 +/- 8 mm Hg, and 28 +/- 12 mm Hg, respectively). CONCLUSION The improved design of the recently introduced third-generation stented bioprosthesis Carpentier-Edwards PERIMOUNT Magna allows implantation of a significantly bigger valve than with the old generation. Furthermore, the improved hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna compares favorably with both the Carpentier-Edwards PERIMOUNT and the Edwards Prima Plus.
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Affiliation(s)
- Pasquale Totaro
- Cardiac Surgery Division, Regional Cardiac Centre, Morriston Hospital, Swansea, United Kingdom.
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Walther T, Lehmann S, Falk V, Metz S, Doll N, Rastan A, Viehweg M, Richter M, Gummert J, Mohr FW. Prospectively Randomized Evaluation of Stented Xenograft Hemodynamic Function in the Aortic Position. Circulation 2004; 110:II74-8. [PMID: 15364842 DOI: 10.1161/01.cir.0000138947.63799.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Standard stented aortic xenograft valves have not yet been compared regarding their hemodynamic function using a stratified intraoperative randomization protocol.
Methods and Results—
100 patients were prospectively included after intraoperative metric sizing of the decalcified aortic annulus. They received Mosaic (M) or Perimount (P) aortic valve replacement. Patient age was 73±5 years, 51 were female, and New York Heart Association (NYHA) functional class was 2.8±0.5. The 21-mm annulus group consisted of 5 (M)/7 (P) patients, the 23-mm annulus group of 20 (M)/20 (P), the 25-mm annulus group of 18 (M)/19 (P), and the 27-mm annulus group of 4 (M)/7 (P) patients, respectively. Hemodynamic function was evaluated using transthoracic echocardiography before discharge and at follow-up (438±352 days). Surgery was uncomplicated in all patients. Labeled valve sizes were 0.93 (M) and 1.05 (P) mm smaller than the annulus diameters (
p
=NS). In-hospital mortality was 5%, all nonvalve-related. Transvalvular blood flow velocities and transvalvular pressure gradients were significantly lower in the 25 P versus the 25 M group at baseline and in the 23 P and 25 P groups at follow-up. There was a significant regression of left ventricular mass index in all patients at follow-up. However, left ventricular mass regression was more pronounced after P aortic valve replacement.
Conclusion—
Labeled sizes of prosthetic heart valves implanted are smaller than the true aortic annulus. Both standard aortic xenografts compared in this prospectively randomized trial provide a sufficient hemodynamic and functional outcome.
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Affiliation(s)
- Thomas Walther
- Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Germany.
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Gao G, Wu Y, Grunkemeier GL, Furnary AP, Starr A. Durability of pericardial versus porcine aortic valves. J Am Coll Cardiol 2004; 44:384-8. [PMID: 15261935 DOI: 10.1016/j.jacc.2004.01.053] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 12/30/2003] [Accepted: 01/27/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study compares the long-term performance of the Carpentier-Edwards (CE) porcine bioprosthesis and the CE pericardial bioprosthesis for aortic valve replacement (AVR). BACKGROUND With new bioprostheses on the horizon, there is renewed interest in how the long-term durability of current pericardial bioprostheses compares with the traditional porcine bioprosthesis. METHODS We reviewed 518 AVR with CE porcine valves from 1974 to 1996 and 1,021 AVR with CE pericardial valves from 1991 to 2002. The age distribution and clinical profiles were similar for both groups. The total (mean) follow-up was 3,322 (6.4) years for porcine and 2,556 (2.5) years for pericardial. RESULTS Long-term mortality was similar (p = 0.29) for porcine and pericardial, with 10-year survival rates of 34 +/- 2% and 38 +/- 6%, respectively. Ten-year freedom from major adverse cardiac events was also similar for both (respectively): thromboembolism (80 +/- 2% and 87 +/- 2%; p = 0.24); endocarditis (98 +/- 1% and 99 +/- 1%; p = 0.30). However, 10-year freedom from explant was lower for porcine (90 +/- 2%) than for pericardial (97 +/- 1%, p = 0.04). Reasons for explant for porcine were structural valve deterioration (SVD) (n = 25), endocarditis (n = 4), and periprosthetic leak (n = 2). The reasons for explant for pericardial were SVD (n = 4), endocarditis (n = 4) and periprosthetic leak (n = 1). CONCLUSIONS The current CE pericardial valve offers better midterm durability than the traditional CE porcine valve. Its freedom from SVD and reoperation makes it our current bioprosthesis of choice for AVR in appropriately selected patients.
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Bottio T, Rizzoli G, Thiene G, Nesseris G, Casarotto D, Gerosa G. Hemodynamic and clinical outcomes with the biocor valve in the aortic position: an 8-year experience. J Thorac Cardiovasc Surg 2004; 127:1616-23. [PMID: 15173715 DOI: 10.1016/j.jtcvs.2003.10.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the 8-year experience, survival, prosthetic complications, and hemodynamics of patients who received the Biocor valve, a new-generation tissue valve, in the aortic position. METHODS From May 1992 through May 2001, 257 consecutive patients (129 women and 128 men; mean age, 75 +/- 6 years; age range, 45-91 years) received 258 aortic Biocor porcine prostheses. One female patient who received 2 Biocor valves in the aortic position during 2 consecutive operations was entered twice in the statistical analysis. Twelve (4.6%) patients had previous aortic valve operations. Preoperatively, 82 (32%) patients were in New York Heart Association functional class III or IV. Associated surgical procedures included coronary artery bypass grafting in 56 (21.7%) patients, aortic annular enlargement or aortoplasty in 20 (8%) patients, and others in 8 (3%) patients. Echocardiography was performed in the majority of long-term survivors (91.6%). Follow-up included 1215 patient-years and was 100% complete, with a median time of 5 patient-years (range, 0.4-10.5 years). RESULTS There were 16 (6.2%) early deaths. According to a univariate analysis, New York Heart Association functional class III or IV, concomitant procedures, ejection fractions of less than 40%, and urgent operations were identified as significant perioperative risk factors. At follow-up, 75 patients died; 8-year actuarial Kaplan-Meier survival was 48% +/- 5%. At 8 years, the actuarial freedom from valve-related death was 92% +/- 2.6%, the freedom from thromboembolism was 93% +/- 2%, the freedom from anticoagulant-related hemorrhage was 95% +/- 2%, the freedom from endocarditis was 99% +/- 0.6%, the freedom from paravalvular leak was 96% +/- 1.5%, the freedom from all valve-related complications was 78% +/- 4.5%, and the freedom from structural valve deterioration was 95% +/- 3.7%. At 8 years, the actuarial freedom from structural valve deterioration was 89% +/- 10% and 95.8% +/- 4% in patients younger and older than 65 years, respectively. At 10 years, in patients older than 65 years, the actual freedom from structural valve deterioration was 97.9% +/- 2.1%, and the freedom from reoperation was 97% +/- 1.3%. New York Heart Association status was I or II in 90% of patients at the end of follow-up. The mean echocardiographic follow-up time was 4.6 +/- 2 years. By using Doppler echocardiography, the peak and mean transprosthetic gradients were determined to be 30.8 +/- 9.3 mm Hg and 16.6 +/- 5.3 mm Hg, respectively. Mean mass/volume ratio and left ventricular end-diastolic volume were 1.37 +/- 0.17 g/mL and 63.4 +/- 22.6 mL/m(2), respectively. The majority of patients showed a persistent left ventricular hypertrophy. CONCLUSION The Biocor is an effective bioprosthesis with a low incidence of valve-related complications comparable with that of other second-generation bioprostheses. This stented porcine prosthesis provides satisfactory results in terms of hemodynamics, valve durability, and freedom from reoperation.
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Affiliation(s)
- Tomaso Bottio
- Department of Cardiovascular Surgery, University of Padua Medical School, Padua,
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Jamieson WRE. Quantification of haemodynamic performance of stented and stentless aortic bioprostheses and potential influence on survival. Heart Lung Circ 2003; 12:149-56. [PMID: 16352124 DOI: 10.1046/j.1444-2892.2003.00208.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The goal of aortic valve replacement is relief of symptoms, optimisation of haemodynamics, regression of left ventricular mass and advancement of survival. The objective of this review article is to provide the evidence-to-date on the clinical performance of stented and stentless heterograft bioprostheses with regard to haemodynamics, durability and survival. METHODS The haemodynamic advantage of aortic valve replacement prostheses is judged on ability to minimise postoperative gradients and to optimise the normalisation of left ventricular mass and function. The most frequent cause of high postoperative gradients occurs when the effective prosthetic valve area is less than that of the normal human valve. The effective orifice area index (EOAI) of >/= 0.85 cm(2)/m(2) is considered optimal to prevent patient-prosthesis mismatch (PPM) at rest and exercise. RESULTS The stented bioprostheses contribute to obstructive non-physiological flow patterns whereas stentless bioprostheses provide laminar non-obstructive flow. The stentless bioprostheses have been shown to have larger effective orifice areas and lower gradients. Mismatch is decreased with stentless bioprostheses especially when prosthesis size is </=21 mm. Left ventricular mass (LVM) postoperatively has been shown to relate to baseline LVM index (LVMI) and PPM. The EOAI >0.8 cm(2)/m(2) provides the best long-term regression of LVM. It has been identified that a tendency for PPM in sizes 21 and 23 mm stented bioprostheses did not prevent adequate achievement of appropriate LVMI. Survival at 5 years favoured stentless over stented bioprostheses for patients <70 years, but not in patients >/= _70 years of age. The durability comparison of the stentless bioprostheses must wait until 10-15 years experience is achieved. There is preliminary evidence that uneven shear stress on the leaflet of a regurgitant stentless bioprosthesis can accelerate leaflet tears at the level of the commissures. Dilation of the aortic root and, particularly, the sinotubular junction, can cause progressive stentless valve insufficiency. CONCLUSIONS The long-term performance advantages or disadvantages of stentless bioprostheses compared to stented bioprostheses will require at least another 5-7 years of cumulative stentless bioprostheses experience. Surgeons can use an algorithm intraoperatively to prevent patient-prosthesis mismatch while choosing the optimal prosthesis.
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