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de la Fuente A, Sánchez JR, Fernández JL, Romero J, Berjon J, Moriones I. The Medtronic Intact Bioprosthesis: Clinical and Hemodynamic Performance Over 13 Years. Artif Organs 2002; 26:851-5. [PMID: 12296924 DOI: 10.1046/j.1525-1594.2002.06984.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated our results over 13 years with the aortic-position Medtronic Intact bioprosthesis. Our study involved 91 consecutive patients with isolated aortic valve replacement with the Medtronic Intact bioprosthesis. The follow-up was complete for 95%. Mean follow-up was 6.61 years (range 16 days-13 years), 590 patient years. Early mortality rate was 3.3%. Late mortality was 23 patients. Survival at 13 years was 53.52% (SD = 7.63%). The linearized rate of major thromboembolism was 0.34% per patient year; rate of major bleeding events was 0.33% per patient year. The rate of nonstructural dysfunction was 0.16% per patient year. Rate of reoperation was 0.53% and rate of structural valve deterioration was 0.16% per patient year. New York Heart Association (NYHA) postoperative classes were I to II in 92.21%. Gradients were as follows: 21 to 23.87 mm Hg, 23 to 18 mm Hg, 25 to 15.5 mm Hg, and 27 to 16.50 mm Hg. Structural valve deterioration was low during the 13 years of follow-up. Valve gradients and areas remained the same over the follow-up period. The Medtronic Intact bioprosthesis shows excellent clinical and hemodynamic performance at 13 years of follow up.
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Neethling WM, van Riet S, van den Heever JJ, Hough J, Hodge AJ. Evaluation of kangaroo aortic valved conduits in a juvenile sheep model: preliminary findings. J Card Surg 2001; 16:392-9. [PMID: 11885771 DOI: 10.1111/j.1540-8191.2001.tb00540.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biological heart valve substitutes, manufactured from either porcine or bovine tissue, have been in use for more than 30 years. Despite low thrombogenicity and excellent performance, bioprosthetic heart valves tend to degenerate and calcify early in young patients because of patient and valve related factors. The aim of this study was to examine the calcification behavior of glutaraldehyde-preserved kangaroo heart valves in a juvenile sheep model. METHODS Porcine (n = 10) and kangaroo (n = 10) valved conduits were implanted in the descending aortic position of juvenile sheep and retrieved after 6, 8, and 12 months. Retrieved valved conduits were examined for morphological changes and calcification of the valve tissue, using Von Kossa's stain technique and atomic absorption spectrophotometry. RESULTS Structural valve deterioration, characterized by increased stiffness and severe calcification, occurred in 100% of the porcine conduits within 4 months. Kangaroo valve leaflets were significantly (p < 0.001) less calcified at 6 months (3.39+/-1.80 microg/mg), 8 months (5.86+/-4.57 microg/mg), and at 12 months (14.38+/-6.72 microg/mg), compared to porcine valves at 3 months (176.45+/-42.88 microg/mg ) and at 4 months (154.67+/-52.67 microg/mg ). Porcine aortic wall tissue was more calcified (118.24+/-42.86 microg/mg) than kangaroo aortic wall tissue (79.55+/-26.40 microg/mg). CONCLUSIONS Kangaroo heart valves calcify less than porcine heart valves. These findings suggest that a different donor valve tissue has a lower calcification potential probably due to a difference in the morphological ultrastructure. This could result in improved long-term durability of kangaroo heart valves.
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Affiliation(s)
- W M Neethling
- Fremantle Heart Institute, Department of Cardiothoracic Surgery, Western Australia.
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Roughneen PT, DeLeon SY, Parvathaneni S, Cetta F, Eidem B, Vitullo DA. The pericardial membrane pulmonary monocusp: surgical technique and early results. J Card Surg 1999; 14:370-4. [PMID: 10875593 DOI: 10.1111/j.1540-8191.1999.tb01012.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Long-term pulmonary insufficiency resulting from simple transannular patching of the right ventricle outflow tract will ultimately lead to deterioration in right ventricular function. Previously, monocusps constructed from xenografts, homografts, fascia lata, and autologous pulmonary artery wall have been utilized to minimize pulmonary regurgitation and its deleterious effect on right ventricular function. However, these tend to degenerate in the long term, necessitating reoperation. To circumvent this problem we have used a monocusp constructed from 0.1-mm polytetrafluorethylene (PTFE, pericardial membrane) clinically demonstrated to be resistant to issue ingrowth and degeneration. Seven children (5 tetralogy of Fallot, 2 pulmonary stenosis) who required division of a small pulmonary annulus underwent monocusp construction with 0.1-mm PTFE. Three patients had previous corrective surgery. One of these patients had a bovine pericardial monocusp placed 8 years previously, which degenerated. Of the remaining two patients, one had a pulmonary valvotomy as a neonate, the other repair of tetralogy of Fallot with a transannular patch. At a mean (+/- standard deviation) follow up to 17+/-5.8 months all patients are alive and are New York Heart Association (NYHA) Class I. Echocardiography demonstrates mild pulmonary insufficiency (PI) in 2 patients, mild to moderate PI in 4, and moderate to severe PI in 1. The presence of a pericardial membrane monocusp in the pulmonary position may, in the long term, prevent the deleterious effects of transannular patching on right ventricular dysfunction and be more resistant to degenerative changes characteristic of monocusps constructed of native pericardium or allogeneic tissue.
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Affiliation(s)
- P T Roughneen
- Department of Thoracic-Cardiovascular Surgery, Loyola University Medical School, Maywood, Illinois, USA
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Eichinger WB, Schütz A, Simmerl D, Gansera BU, Breuer M, Haslinger B, Kemkes BM. The mosaic bioprosthesis in the aortic position: hemodynamic performance after 2 years. Ann Thorac Surg 1998; 66:S126-9. [PMID: 9930432 DOI: 10.1016/s0003-4975(98)01121-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The Mosaic bioprosthesis is a porcine valve combining several new features to improve hemodynamics and durability: a low profile stent for reduced flow obstruction, zero pressure fixation to maintain the natural collagen crimp, and the amino oleic acid antimineralization treatment to enhance durability. METHODS Fifty-five Mosaic valves were implanted in the aortic position since February 1994. Data from these patients (group 1) were compared with data from 52 patients who had received a Hancock Modified Orifice II aortic valve (group 2). The mean patient age was 72.0 (+/-5.9) years for group 1 and 76.8 (+/-4.7) years for group 2. Clinical examinations including transthoracic echocardiography were performed 6 and 24 months postoperatively. RESULTS Mild aortic insufficiencies were found in 2 patients in group 1 and in 3 patients in group 2. There were no embolic or bleeding complications. One Mosaic patient required reoperation due to mitral insufficiency. During the reoperation, a small (approximately 3 mm) thrombus was noted on the outflow side of a Mosaic cusp. The valve was removed and replaced prophylactically. In the 2-year follow-up, hemodynamic measurements showed mean pressure gradients of 12.4 mm Hg for the 21 mm, 11.3 mm Hg for the 23 mm, and 15.4 mm Hg for the 25 mm prostheses in the Hancock group. In the Mosaic group, mean pressure gradients were 14.8 mm Hg for the 21 mm, 10.9 mm Hg for the 23 mm, and 11.5 mm Hg for the 25 mm valves. Differences between pressure gradients and effective orifice areas of the Hancock and the Mosaic valves were not statistically significant. Early mortality in group 1 was 3.6% and in group 2 3.8%. Overall mortality was 12.7% and 13.5%, respectively. CONCLUSIONS The Mosaic valve has low pressure gradients for all sewing ring diameters. Compared with the Hancock Modified Orifice valve, there was no statistically significant gradient difference but a tendency toward better hemodynamics was noted in the Mosaic group after 2 years.
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Affiliation(s)
- W B Eichinger
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany.
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Abstract
OBJECTIVE Our objective was to assess the long-term mortality and morbidity associated with the Medtronic Intact valve (Medtronic, Inc, Minneapolis, Minn). METHOD Between 1983 and 1996, 447 patients (280 men and 167 women) received 466 Intact valves: 280 aortic, 156 mitral, and 30 tricuspid. The mean age was 57 years (median 63 years), with 45% younger than 60 years. The mean New York Heart Association class was 3.1. The follow-up was 98% complete and extended for 39 months (1-154 months) and 1324 patient-years. There were 32 valves at risk at 10 years after implantation. Doppler echocardiography was performed whenever possible in patients followed up for longer than 4 years (mean 8 years) after implantation. RESULTS Ten-year overall actuarial survival was 30% +/- 6% (14% +/- 7% for New York Heart Association classes IV-V and 39% +/- 8% for classes I-III). At 10 years freedom from infective endocarditis was 92% +/- 3%, freedom from thromboembolism was 80% +/- 5%, and freedom from nonstructural valve deterioration was 95% +/- 2%. Ten-year freedom from explantation was 64% +/- 6%, freedom from valve-related events was 51% +/- 6%, and freedom from valve-related death was 88% +/- 3%. There were 26 examples of structural valve deterioration, mainly caused by leaflet calcification (in 17 cases) and by buttress detachment (in 6 cases). In the aortic position at 10 years freedom from structural valve deterioration was 81% +/- 9%, but with only 1 event in patients older than 40 years (freedom 92% +/- 8%) and 100% freedom in patients older than 60 years. There was also 100% freedom from structural valve deterioration in the tricuspid position. In the mitral position freedom was 65% +/- 8%, with no significant difference between age groups. CONCLUSION The Intact valve provides superior results in the aortic position in patients older than 40 years and in the tricuspid position at all ages.
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Affiliation(s)
- B G Barratt-Boyes
- Departments of Cardiac Surgery, Cardiology and Clinical Physiology, and Statistics, Green Lane Hospital, Auckland, New Zealand
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Fernandez J, Chen C, Gu J, Brdlik OB, Laub GW, Murphy MM, Adkins MS, Anderson WA, McGrath LB. Comparison of low-pressure versus standard-pressure fixation Carpentier-Edwards bioprosthesis. Ann Thorac Surg 1995; 60:S205-10. [PMID: 7646160 DOI: 10.1016/0003-4975(95)00201-u] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Intermediate-phase clinical results of 51 low-pressure (LP) and 234 standard-pressure (SP) fixation porcine Carpentier-Edwards (CE) valves implanted between 1977 and 1991 were compared for valve-related events. Group similarities included New York Heart Association functional class, ejection fraction, and sex. Patients with SP valves were younger (mean age, 58 versus 68 years; p = 0.0001). There were 20 in-hospital deaths (8.6%) in the SP valve group and 5 (9.8%) in the LP valve group (p = 0.79). Follow-up was 99%, with a mean of 104 months in the SP valve group versus 55 months in the SP valve group (p = 0.0001). The actuarial survival rate was 48.2% and 22.3% at 10 and 15 years, respectively, in the SP valve group and 34.1% at 10 years in the LP valve group (p = 0.42). Freedom from events at 5, 10, and 15 years in the SP valve group and at 5 years in the LP valve group was as follows: for late valve-related events, 86.3%, 51.4% and 20.2%, respectively, in the SP valve group versus 85% in the LP valve group (p = 0.44); for valve-related death, 96.4%, 93.6%, and 87.3% in the SP valve group versus 100% in the LP valve group (p = 0.20); for structural valve failure, 96%, 68%, and 35% in the SP valve group versus 100% in the LP valve group (p = 0.09); and for reoperation, 95%, 61%, and 30% in the SP valve group versus 92% in the LP valve group (p = 0.82). In conclusion, this study revealed no significant statistical difference between LP and SP valves. In the LP valve group, structural valve failure/valve-related death was not observed, perhaps indicating a more favorable result. Absolute verification of this trend awaits long-term follow-up.
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Affiliation(s)
- J Fernandez
- Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015, USA
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Lemieux MD, Jamieson WR, Landymore RW, Dumesnil JG, Métras J, Munro AI, Raymond G, Tyers GF, Cartier PC, Ali IM. Medtronic Intact porcine bioprosthesis: clinical performance to seven years. Ann Thorac Surg 1995; 60:S258-63. [PMID: 7646169 DOI: 10.1016/0003-4975(95)00268-p] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The clinical performance of the Medtronic Intact porcine bioprosthesis was evaluated in 1,084 patients (mean age 66.4 years, range 9 to 91 years) who had a total of 1,099 implantations between 1985 and 1992, inclusive. There were 709 aortic valve replacements, 297 mitral valve replacements, and 80 multiple valve replacements. Concomitant procedures were performed in 432 (39.3%). The age group distribution (years) was 35 or younger in 20 patients, 36 to 50 in 64, 51 to 64 in 274, 65 to 69 in 225, 70 or older in 500. The total follow-up time was 2,741 patient-years (mean, 2.5 years) and was 97.5% complete. The early mortality rate was 7.1% and late mortality was 3.9% per patient-year. The overall patient survival at 7 years was 70% +/- 3%. The freedom from major thromboembolism was 94% +/- 1% at 7 years (p = not significant for valve positions). The freedom from reoperation at 7 years was 93% +/- 1%; freedom from valve-related mortality was 89% +/- 2%. The freedom from structural valve deterioration at 7 years was 97% +/- 1% (aortic valve replacement 97% +/- 1%; mitral valve replacement 97% +/- 2%). The freedom from structural valve deterioration among age groups was not different for the overall population, aortic valve replacement, or mitral valve replacement. Hemodynamic assessment revealed obstructive properties for aortic valve replacement sizes of 21 and 23 mm and for mitral valve replacement sizes of 25 and 27 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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O'Brien MF, Stafford EG, Gardner MA, Pohlner PG, Tesar PJ, Kear L, Smith SE. The Medtronic Intact xenograft: an analysis of 342 patients over a seven-year follow-up period. Ann Thorac Surg 1995; 60:S253-7. [PMID: 7646168 DOI: 10.1016/0003-4975(95)00534-r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Three hundred forty-two patients from December 1985 to January 1993 received 352 Medtronic Intact porcine xenograft valves (zero-pressure glutaraldehyde-fixed with toluidine blue anticalcification agent). The follow-up was 99.4% complete with a mean of 3.14 years (3 months to 7.9 years). The mean patient age was 64 years (range, 16 to 82 years) and the median age was 67 years. There were 14 aortic valve replacement patients (11.9%) and 62 mitral valve replacement patients (29.2%) who preoperatively were in New York Heart Association class IV to V. The hospital mortality was 8.4% +/- 2.9% (aortic valve replacement, 5.9%; mitral valve replacement, 9.4%; tricuspid valve replacement, 7.6%). Actuarial patient survival at 7 years was 65% +/- 5% (aortic valve replacement, 77% +/- 5%; mitral valve replacement, 63% +/- 5%). At 7 years, the freedom from thromboembolism was 74% +/- 4%, freedom from endocarditis 93% +/- 2%, and freedom from reoperation 90% +/- 3%. Reoperation was required for endocarditis (7 patients), periprosthetic leak (6), and 2 of 3 cases of structural deterioration. The actuarial freedom from structural deterioration at 5 years was 97% +/- 3%. The combined incidence of all important morbid valve-related events was analyzed with an actuarial freedom at 7 years of 63% +/- 3%. The durability of the Medtronic Intact is at least equal to that of other porcine bioprostheses. The relevant important time-frame of 7 to 12 years of follow-up has just begun, and possibly the reoperation rate for intrinsic value failure and the low incidence of calcification in the elderly patient may be showing improved characteristics of this valve. No stronger inferences are possible at this stage of the 7-year follow-up.
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Affiliation(s)
- M F O'Brien
- Department of Cardiac Surgery, Prince Charles Hospital, Brisbane, Australia
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Abstract
The choice of bioprostheses and mechanical prostheses as valvular substitutes for cardiac valve replacement surgery has existed for over 20 years. The extensive developments over the past three decades have been introduced to reduce or eliminate valve related complications, namely thromboembolism, anticoagulant related hemorrhage, and structural failure, as well as to optimize hemodynamic performance. The biological valvular prostheses, namely porcine aortic or bovine pericardium, have been developed with tissue preservation, together with stent designs, that contribute to preservation of anatomical characteristics and biomechanical properties of the leaflets. The mechanical prostheses have been developed to eliminate structural failure, to facilitate prevention of blood status and thrombus formation, to facilitate radiopacity for evaluation of prosthesis function, and to facilitate intraoperative leaflet positioning. The implantation of the various present generation bioprostheses and mechanical prostheses requires special considerations to avoid technical complications and support ventricular performance. The studies of biological and mechanical prostheses, both randomized and nonrandomized, as well as specific prosthesis assessments, have contributed to the establishment of indications for types of prostheses. Bioprostheses have a high risk of structural failure and reoperation, while mechanical prostheses have a high risk of thromboembolism and anticoagulant hemorrhage. Within the bioprostheses population, the risk factors for structural valve deterioration are younger age and mitral prosthesis. Older patients (> 65 years of age) have a greater risk of valve related complications with mechanical prostheses, while younger patients (< 40 years of age) are at greater risk with bioprostheses. Comparison of large bioprostheses and mechanical prostheses populations by age groups revealed that regardless of the differences in the freedom from structural valve deterioration, the freedom from treatment failure (valve related mortality and permanent impairment from thromboembolism, anticoagulant hemorrhage, and septal emboli from prosthetic valve endocarditis) is essentially the same for mechanical prostheses and bioprostheses at 10 years. The quality of life is superior with bioprostheses, while patient survival and total valve related morbidity/mortality are similar with both types of prostheses.
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Affiliation(s)
- W R Jamieson
- Department of Surgery, University of British Columbia, Vancouver, Canada
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Valente M, Minarini M, Maizza A, Bortolotti U, Thiene G. Heart valve bioprosthesis durability: a challenge to the new generation of porcine valves. Eur J Cardiothorac Surg 1992. [DOI: 10.1093/ejcts/6.supplement_1.s82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roughneen PT, DeLeon SY, Parvathaneni S, Cetta F, Eidem B, Vitullo DA. The Pericardial Membrane Pulmonary Monocusp: Surgical Technique and Early Results. Echocardiography 1985. [DOI: 10.1111/j.1540-8175.1985.tb01309.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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