Carpentier-Edwards Bioprosthesis: Structural Deterioration by Age Groups

The Carpentier-Edwards supra-annular porcine bioprosthesis (second generation prosthesis) was implanted in 2438 patients in 2482 operations between 1982 and 1992. The mean age of the population was 64 years with a range from 21 years to 89 years. There were 1334 aortic and 934 mitral valve replacements. The population was divided into five groups: 21 to 40 years (n = 132); 41 to 50 years (n = 189); 51 to 60 years (n = 454); 61 to 70 years (n = 849); and over 70 years (n = 858). There was no difference in sunival by valve position for age groups 21 to 40 years and 41 to 50 years. Sunival within the age groups 51 to 60 years, 61 to 70 years, and over 70 years was greater for patients with aortic compared with mitral and multiple valve replacements. The freedom from structural valve deterioration at 10 years for all age groups was highest for valves in the aortic position. Patients with valves in the mitral position had a higher freedom from structural valve deterioration at 10 years than those who had multiple valve replacement, although not all the differences were significant. There was a lower incidence of structural valve deterioration in the older age groups. We concluded that the use of the Carpentier-Edwards supra-annular porcine bioprosthesis for aortic valve replacement can be extended to patients over 60 years of age, while its use for mitral valve replacement can be extended to those above 70 years of age.

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Minimally Invasive Transaortic Repair of the Mitral Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20101133 ◽

2011 ◽

Vol 14 (4) ◽

pp. 232 ◽

Cited By ~ 2

Author(s):

Orlando Santana ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Operative Mortality ◽

The Mean ◽

Transaortic Approach

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1685178 ◽

2019 ◽

Vol 68 (07) ◽

pp. 595-601

Author(s):

Markus Schlömicher ◽

Matthias Bechtel ◽

Zulfugar Taghiyev ◽

Hamid Naraghi ◽

Peter Lukas Haldenwang ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Valve Surgery ◽

Actuarial Survival ◽

Intermediate Outcomes ◽

The Mean ◽

Rapid Deployment

Abstract Background Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures Methods Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. Results The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. Conclusions Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.

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Mitroflow Pericardial Bioprosthesis: Experience to Seven Years

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239300100305 ◽

1993 ◽

Vol 1 (3) ◽

pp. 123-128 ◽

Cited By ~ 1

Author(s):

W.R. Eric Jamieson ◽

Alfred N. Gerein

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Prosthetic Valve ◽

Clinical Performance ◽

Prosthetic Valve Endocarditis ◽

Structural Valve Deterioration ◽

Related Mortality

Between 1983 and 1987, the Mitroflow pericardial prosthesis was implanted in 99 patients, ranging in age from 28 to 94 years (mean 62.8 years). Early mortality was 6.1% (6 patients), and late mortality was 4.8% per patient-year (22 patients). Total cumulative follow-up was 458 patient-years (mean 4.6 years). At 7 years, patient survival was 62% for aortic valve replacement and 63% for mitral valve replacement. The overall rate of valve-related complications was 7.4% per patient-year (34 events): thromboembolism, 2.8%; antithromboembolic-relatedhemorrhage, 1.1%; prosthetic valve endocarditis, 0.7%; non-structural dysfunction, 0.7%; and structural valve deterioration, 2.8%. At 7 years, freedom from thromboembolism was 80.3%, and freedom from prosthetic valve endocarditis was 95.5%. At 5 and 7 years, freedom from structural valve deterioration was 93.4% and 69.7%, respectively. At 5 years, freedom from structural valve deterioration was 97.3% for aortic valve replacement (AVR), 86.6% for mitral valve replacement (MVR), and 100% for multiple valve replacement (MR). At 7 years, freedom from structural valve replacement was 84.6% and 61.3% for AVR and MVR, respectively. At 7 years, overall freedom from reoperation was 68.2%; from valve-related mortality, 81.4%; from valve-related residual morbidity, 97.4%; and from treatment failure (valve-related mortality and residual morbidity), 79.0%. At 7 years, the Mitroflow pericardial bioprosthesis has provided satisfactory clinical performance, especially in the aortic position, with an acceptable freedom from structural valve deterioration.

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Inverted aortic bioprosthetic for mitral valve replacement with Ross procedure: case report

The Cardiothoracic Surgeon ◽

10.1186/s43057-021-00041-8 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Iain McPherson ◽

Christopher Bayliss ◽

Tommaso Generali ◽

Karen Booth ◽

Asif Hasan

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Lv Function ◽

Ross Procedure ◽

Mitral Valve Leaflet ◽

Pulmonary Autograft ◽

Structural Valve Deterioration ◽

Aortic Homograft

Abstract Background A 34-year-old gentleman presented with Staphylococcus salivarius infective endocarditis 13 years after aortic homograft and mitral valve repair for degenerative bicuspid aortic valve associated with rheumatic heart disease. The homograft had calcified, and the mitral repair had deteriorated with severe regurgitation. Multidisciplinary team decision to restore best quality of life was for re-do Ross procedure with bi-leaflet preserving mitral valve replacement with an inverted RESILIA aortic valve as the patient was fundamentally against lifelong anti-coagulation. Case presentation The aortic homograft was excised, and coronary arteries dissected out followed by harvesting of the pulmonary autograft. The mitral valve was accessed via a trans-septal approach. On examination, there was a restricted and thickened posterior mitral valve leaflet. An inverted 27-mm INSPIRIS RESILIA aortic bio-prosthesis was placed with mitral cusps preserved. The pulmonary autograft was implanted in an intra-annular position, and a 26-mm pulmonary homograft was used to replace the pulmonary valve. Echocardiogram at 4 weeks revealed preserved LV function and well-functioning prosthetic, autograft and homograft. Conclusion An inverted RESILIA valve, with its anti-structural valve deterioration properties, can be used in the mitral position with preservation of the mitral cusps to avoid anti-coagulation with the hope of reducing need for re-operation in line with patient wishes.

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Surgical explantation of a failed transcatheter aortic valve

10.1510/mmcts.2021.056 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Lower Risk ◽

Transcatheter Aortic Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Native Valve ◽

Transcatheter Aortic Valve ◽

Structural Deterioration ◽

Structural Valve Deterioration

With transcatheter aortic valve replacement being increasingly utilized in a younger and lower risk population, we can expect to see larger numbers of patients presenting with structural deterioration of aortic valves replaced by the transcatheter route that now require explantation and surgical replacement. Surgical aortic valve replacement after transcatheter aortic valve replacement is associated with operative morbidity and mortality rates significantly higher than those seen in the setting of surgical replacement of the native valve, which had a 30-day mortality of 12–20% in recent series. Centers performing transcatheter aortic valve replacement in lower risk patients with longer expected lifespans and a higher probability of late structural deterioration of the transcatheter aortic valve replacement should carefully consider their choice of valve type (balloon-expandable versus self-expanding) and patient anatomy, including annulus and root diameter, at the time of the initial valve intervention. Further, one should not forget the mechanical surgical aortic valve replacement option in younger patients with risk factors for early structural valve deterioration such as obesity, metabolic syndrome, and chronic kidney disease. The objectives of this tutorial are to describe the preoperative workup for a patient with late structural valve deterioration after transcatheter aortic valve replacement, detail the explantation approach specific to self-expanding valves, and illustrate the key decisions and techniques needed for subsequent surgical aortic valve replacement.

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Continuous Beta-Blocker Therapy Delays Structural Deterioration after Bioprosthetic Mitral Valve Replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1692651 ◽

2019 ◽

Vol 67 (07) ◽

pp. 554-556

Author(s):

Wenrui Ma ◽

Yan Tan ◽

Qiuxia Shi ◽

Zhiwei Xu

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Beta Blocker ◽

Blocker Therapy ◽

Structural Deterioration ◽

Structural Valve Deterioration ◽

The Impact ◽

Bioprosthetic Mitral Valve

AbstractThe impact of continuous beta-blocker (BB) therapy on structural valve deterioration (SVD) after bioprosthetic mitral replacement was investigated. From 2000 to 2005, 138 such patients were propensity score matched in a 1:1 fashion (continuous BB therapy after surgery, n = 69; without BB therapy, n = 69). Median follow-up was 12.3 years. Cardiac mortality was comparable between patients with and without BB therapy (p = 0.13), while the 10-year freedom from SVD was significantly higher in patients with BB therapy (92.4 vs. 76.3%, p = 0.001). In conclusion, continuous BB therapy may be considered in patients after bioprosthetic mitral valve replacement to delay SVD and improve prosthetic durability.

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Mid-term assessment of structural valve deterioration of perceval S sutureless prosthesis using the last European consensus definition

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa299 ◽

2020 ◽

Author(s):

José Manuel Martínez-Comendador ◽

Francisco Estevez-Cid ◽

Miguel González Barbeito ◽

Carlos Velasco García De Sierra ◽

Alberto Bouzas Mosquera ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Pressure Gradient ◽

Valve Replacement ◽

Consensus Definition ◽

Structural Valve Deterioration ◽

Mean Pressure ◽

The Mean ◽

Bioprosthetic Valves

Abstract OBJECTIVES Durability of sutureless aortic bioprosthetic valves remains a major issue. The aim of this study was to assess structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) of the Perceval bioprosthesis using the new proposed standardized definitions. METHODS All patients who underwent aortic valve replacement with sutureless Perceval S prostheses up to September 2016 were included. Clinical and echocardiographic follow-up was performed. New standardized definitions were used to assess the durability of sutureless bioprosthetic valves. From 2013 to 2016, 214 patients were included. RESULTS The mean age and EuroSCORE II were 79 years and 2.74. Thirty-day mortality was 0.47%. The survival rate was 96.8%, 88.1% and 85.7% at 1, 3 and 4 years, respectively. The median echocardiographic follow-up was 3.28 years. The mean pressure gradient was 11.3 mmHg. No cases showed evidence of severe SVD, 17 patients had moderate SVD with a mean pressure gradient of 24 mmHg and 8 patients had definite late BVF. The incidence of moderate SVD and BVF at 4 years was 8.8% and 2.9%, respectively. CONCLUSIONS Mid-term follow-up to 6.3 years after aortic valve replacement with the Perceval bioprosthesis documents favourable haemodynamic and clinical outcomes and low rates of SVD and BVF.

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Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000306 ◽

2016 ◽

Vol 11 (6) ◽

pp. 425-429 ◽

Cited By ~ 1

Author(s):

Christos G. Mihos ◽

Maiteder Larrauri-Reyes ◽

Judy Hung ◽

Orlando Santana

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

The Mean

Objective The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. Methods We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015. The MR was graded semiquantitatively as 0 (trace/none), mild moderate (2+), or moderate to severe (3–4+). Results Thirty-two patients had aortic stenosis, and eight had aortic regurgitation. The mean ± standard deviation (SD) age was 77.5 ± 5 years, 34 (85%) were male, and the mean ± SD EuroSCORE II was 14.3% ± 12.9. At a median follow-up of 1 month (interquartile range, 0.75–10), there were significant improvements in preoperative versus postoperative median MR grade (3+ vs 1+, P < 0.001), mean left ventricular ejection fraction (34% vs 41%, P = 0.018), left ventricular end-diastolic diameter (54 vs 49 mm, P = 0.005), and pulmonary artery systolic pressure (49 vs 35 mm Hg, P < 0.001). Persistent 3 to 4+ MR occurred in two patients (5%). In 12 patients with at least 6-month follow-up (mean ± SD, 18 ± 11 months), a sustained improvement in all echocardiographic parameters was observed, with persistent 3 to 4+ MR occurring in one patient (8.3%). Actuarial survival at 1, 3, and 4.5 years was 82% ± 6, 71% ± 8, and 65% ± 10, respectively. Conclusions A transaortic edge-to-edge repair for 2+ or greater functional MR can be safely performed during aortic valve replacement and is associated with improvements in MR grade, left ventricular remodeling, and pulmonary hemodynamics.

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Reintervention for the trifecta aortic bioprosthesis: large single-centre series

European Heart Journal ◽

10.1093/eurheartj/ehab724.2252 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Fard ◽

N Al-Attar

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Survival Data ◽

Single Centre ◽

Funding Sources ◽

Structural Valve Deterioration ◽

The Mean ◽

Mean Time

Abstract Introduction Aortic valve replacement with the Trifecta aortic bioprosthesis has reported favourable haemodynamic performance. However, several reports of structural valve deterioration have raised concerns of design risks and its long-term durability. Purpose We conducted this study to assess reintervention and outcomes in a large single-centre cohort of 944 patients receiving the Trifecta valve over a 10-year period. Methods Consecutive patients undergoing aortic valve replacement with the Trifecta valve between October 2011 and October 2020 in our centre were included in this study. Perioperative patient and operative characteristics were prospectively recorded in an independent database. Reintervention was recorded as a surrogate for structural valve deterioration, and survival data was analysed. Results A total of 944 patient (mean age 72.82 years ± 8.13, range 28–91, 58% male) underwent aortic valve replacement with the Trifecta valve in our centre between October 2011 and October 2020. At 10-years, 1.4% of patients required a redo operation for aortic valve replacement, giving an overall freedom reintervention of 98.6%, with a 99.3% and 99.4% freedom from reintervention due to structural valve deterioration and infection, respectively. The mean time to all-cause reintervention was 48.87 months, and the mean time to reintervention due to SVD was 68.87 months. Patients that did not require reintervention had a 97.74% freedom from mortality and those that underwent reintervention had a freedom from mortality of 84.62% with a median survival of 69-days. Conclusions In a large single-centre cohort, the Trifecta aortic bioprosthesis was safe with a 1.4% all-cause reintervention rate and a 0.7% reintervention rate for structural valve deterioration at 10-years. FUNDunding Acknowledgement Type of funding sources: None.

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