A Case of Prosthetic Valve Dysfunction Early after Surgery Using a Mosaic Bioprosthesis

Shojima, Takahiro; Yagi, Hiroshi; Enomoto, Naofumi; Sakashita, Hideaki; Oda, Tatsuya; Hosokawa, Yukio; Todo, K

doi:10.4326/jjcvs.39.118

Cited by 1 publication

(1 citation statement)

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“…Other Japanese reports noted that eccentric subvalvular pannus overgrowth was detected in two patients, who required redo AVR within 3 years after the initial operation. 7,8) Both reports speculated that the distortion of the bioprosthetic stent might produce fast turbulence underneath the Mosaic valve, resulting in eccentric pannus formation after the early period from the initial AVR. In contrast, our results speculated that implantation of the Mosaic valve without distortion would result in circumferential and proportional pannus overgrowth during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position

Hirota

Isomura

Yoshida

et al. 2016

ATCS

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IntroductionCurrently, the bioprosthetic aortic valve consisting of bovine pericardium or porcine aortic valve is one of standard and reliable substitutes for excellent hemodynamic performance and durability. 1,2) Satisfactory clinical outcomes were also achieved by the bioprostheses in patients younger than 70 years of age, although reoperations were required due to various causes such as structural valve deterioration (SVD). 3,4) Possible pathology of SVD included restriction of leaflet mobility by calcium deposition, and tear or perforation of the leaflet by mechanical stress over 10 years. In addition to these pathologies, pannus overgrowth was one of the coexisting alterations to affect valvular function, which was observed in 64% of explanted Hancock II porcine valve. 5) Although pannus overgrowth by itself was not the pathology of SVD, it might be related to reoperation for SVD despite improvement of anticalcification treatment for leaflets.We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis (Medtronic Inc, Minneapolis, Minnesota, USA). The macroscopic appearance of explanted valves was examined to detect the presence of pannus formation. Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic PositionMasanori Hirota, MD, PhD, 1,2 Tadashi Isomura, MD, PhD, 1,2 Minoru Yoshida, MD, 2 Chieko Katsumata, MD, 1 Fusahiko Ito, MD, 1 and Masazumi Watanabe, MD 1 Purpose: Although pannus overgrowth by itself was not the pathology of structural valve deterioration (SVD), it might be related to reoperation for SVD of the bioprostheses. Methods: We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis and macroscopic appearance of the explanted valves was examined to detect the presence of pannus. Results: There were 10 patients and the age for the initial aortic valve replacement was 72 ± 10 years old. The duration of durability was 9.9 ± 2.0 years. Deteriorated valve presented stenosis (valvular area of 0.96 ± 0.20 cm 2 ; pressure gradient of 60 ± 23 mmHg). Coexisting regurgitant flow was detected in two cases. Macroscopically, subvalvular pannus overgrowth was detected in 8 cases (80%). The proportion of overgrowth from the annulus was almost even and pannus overgrowth created subvalvular membrane, which restricted the area especially for each commissure. In contrast, opening and mobility of each leaflet was not severely limited and pannus overgrowth would restrict the area, especially for each commissure. In other two cases with regurgitation, tear of the leaflet on the stent strut was detected and mild calcification of each leaflet restricted opening. Conclusion: In patients with the Mosaic aortic bioprosthesis, pannus overgrowth was the major cause for reoperation.

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Section: Discussionmentioning

confidence: 99%