Aortic Valve Replacement With the Medtronic Mosaic Bioprosthesis: A 13-Year Follow-Up

Celiento, Michele; Ravenni, G; Milano, Aldo Domenico; Pratali, Stefano; Scioti, Giovanni; Nardi, Carmela; Bortolotti, Uberto

doi:10.1016/j.athoracsur.2011.10.062

Cited by 31 publications

(31 citation statements)

References 16 publications

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“…[6][7][8][9]19 Data concerning the long-term performance of the MB have been presented by Riess and colleagues 10,20 and, more recently, by Celiento and associates, 11 who reported a 10-to 13-year follow-up. Indeed, most of the data currently available concerning the MB refer to patients after AVR, whereas the performance of the MB after MVR has been evaluated mostly in multicenter studies, with short follow-up reports.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, data on the 13-year follow-up evaluation of the MB-when used for aortic valve replacement (AVR)-have become available. 10,11 However, little is known about the long-range performance of this device in the mitral position. We have therefore reviewed our experience with use of the MB for mitral valve replacement (MVR), and we present herein the results of our study.…”

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confidence: 99%

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The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Celiento¹,

Blasi²,

Martino³

et al. 2016

Texas Heart Institute Journal

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We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 ± 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred in 31 patients (5 valve-related). Actuarial survival rates at 5, 10, and 15 years were 74% ± 5%, 50% ± 6%, and 37% ± 8%. The mean NYHA class in survivors was 1.4 ± 0.6 (P <0.0001). Thromboembolic episodes occurred in 4 patients, with an actuarial freedom at 15 years of 91% ± 5%. No cases of endocarditis were observed. Four patients needed reoperation, 2 for structural failure, and 1 each for perivalvular leakage and valve thrombosis. Actuarial freedom from structural failure and from reoperation, respectively, was 93% ± 5% and 91% ± 5% at 15 years. Echocardiographic follow-up in 24 patients with 27-mm prostheses showed a mean gradient of 5 ± 1.7 mmHg and an effective orifice area of 1.57 ± 0.3 cm2; in 16 patients with 29-mm prostheses, the mean gradient was 4.5 ± 1.9 mmHg, and the effective orifice area, 1.63 ± 0.4 cm2. During nearly 17 years of follow-up, the Mosaic bioprosthesis has shown good overall clinical and hemodynamic performance after mitral valve replacement.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Celiento¹,

Blasi²,

Martino³

et al. 2016

Texas Heart Institute Journal

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“…4) Similarly, in Italian study, SVD was associated with tear and calcification. 6) In our Japanese study, leaflet tear and calcification were not the predominant pathology and subvalvular pannus overgrowth was detected in 80% of SVD cases. 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.…”

Section: Discussionmentioning

confidence: 62%

“…2,4,6) However, the mechanism responsible for valve failure seemed different among the studies. In Canadian multicenter analysis reported by Jamieson et al, leaflet tear was the predominant lesion, but not calcification.…”

Section: Discussionmentioning

confidence: 99%

“…12) Accordingly, when pannus formation would have not been progressed, estimated longer durability would be consistent with earlier reports. 2,4,6) However, Lawton and associates, showed four cases with SVD caused by calcified leaflets in the early period after Mosaic valve implantation (3-44 months). 13) Although pannus was detected in two cases (50%), the pathology of the leaflets was apparently different from our series.…”

Section: Discussionmentioning

confidence: 99%

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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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Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves

Tong,

Cai,

Wang

et al. 2024

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Valvular heart disease (VHD) has become a burden and a growing public health problem in humans, causing significant morbidity and mortality worldwide. An increasing number of patients with severe VHD need to undergo heart valve replacement surgery, and artificial heart valves are in high demand. However, allogeneic valves from donors are lacking and cannot meet clinical practice needs. A mechanical heart valve can activate the coagulation pathway after contact with blood after implantation in the cardiovascular system, leading to thrombosis. Therefore, bioprosthetic heart valves (BHVs) are still a promising way to solve this problem. However, there are still challenges in the use of BHVs. For example, their longevity is still unsatisfactory due to the defects, such as thrombosis, structural valve degeneration, calcification, insufficient re‐endothelialization, and the inflammatory response. Therefore, strategies and methods are needed to effectively improve the biocompatibility and longevity of BHVs. This review describes the recent research advances in BHVs and strategies to improve their biocompatibility and longevity.

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Aortic Valve Replacement With the Medtronic Mosaic Bioprosthesis: A 13-Year Follow-Up

Cited by 31 publications

References 16 publications

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position

Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves

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