Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience

Kono, Takanori; Takagi, Kazuyoshi; Saku, Kosuke; Kikusaki, Satoshi; Zaima, Yasuyuki; Shojima, Takahiro; Takaseya, Tohru; Arinaga, Koichi; Tayama, Eiki

doi:10.1007/s10047-021-01262-8

Cited by 3 publications

(3 citation statements)

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“…3 There are conflicting reports on rates of structural valve deterioration, reoperation, and methodologies on how to assess hemodynamic function between bovine pericardial and porcine stented prosthetic mitral replacement. [13][14][15][16][17] Given the heterogeneity of mitral bioprosthesis valve design, there gradients. This study demonstrates that manufacturer-labeled device sizing number is not consistent across manufacturers and should not be used as a clinical determinant for device size implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Internal diameters of surgical valves vary significantly depending on manufacturer, not only at the level of the tissue annulus, but additionally at the level of the ventricular struts 3 . There are conflicting reports on rates of structural valve deterioration, reoperation, and methodologies on how to assess hemodynamic function between bovine pericardial and porcine stented prosthetic mitral replacement 13–17 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of a new bioprosthetic mitral valve to other commercially available devices under controlled conditions in a porcine model

Wang

Caranasos

O’Neill

et al. 2021

Journal of Cardiac Surgery

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Background/Aim: To evaluate three mitral bioprostheses (of comparable measured internal diameters) under controlled, stable, hemodynamic and surgical conditions by bench, echocardiographic, computerized tomography and autopsy comparisons preand postvalve implantation.Methods: Fifteen similar-sized Yorkshire pigs underwent preprocedural computerized tomography anatomic screening. Of these, 12 had consistent anatomic features and underwent implantation of a mitral bioprosthesis via thoracotomy on cardiopulmonary bypass (CPB). Four valves from each of three manufacturers were implanted in randomized fashion: 27-mm Epic, 27-mm Mosaic, and 25-mm Mitris bioprostheses. After CPB, epicardial echocardiographic studies were performed to assess hemodynamic function and define any paravalvular leaks, followed by postoperative gated contrast computerized tomography. After euthanasia, animals underwent necropsy for anatomic evaluation.Results: All 12 animals had successful valve implantation with no study deaths. Postoperative echocardiographic trans-valve gradients varied among bioprosthesis manufacturers. The 25-mm Mitris (5.1 ± 2.7)/(2.6 ± 1.3 torr) had the lowest peak/mean gradient and the 27-mm Epic bioprosthesis had the highest (9.2 ± 3.7)/(4.6 ± 1.9 torr). Surgical valve opening area (SOA) varied with the 25-mm Mitris having the largest SOA (2.4 ± 0.15 cm 2 ) followed by the 27-mm Mosaic (2.04 ± 0.23 cm 2 ) and the 27-mm Epic (1.8 ± 0.27 cm 2 ) valve. Bench device orthogonal internal diameter measurements did not match manufacturer device size labeling: 25-mm Mitris (23 × 23 mm), 27-mm Mosaic (23 × 22 mm), 27-mm Epic (21 × 21 mm).Conclusions: Current advertisement/packaging of commercial surgical mitral valves is not uniform. This study demonstrates marked variations in hemodynamics, valve opening area and anatomic dimensions between similar sized mitral bioprostheses. These data suggest a critical need for standardization and close scientific evaluation of surgical mitral bioprostheses to ensure optimal clinical outcomes.

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