The fate of small-size pericardial heart valve prostheses in an older patient population

Paulis, Ruggero De; D'Aleo, Salvatore; Bellisario, Alessandro; Salica, Andrea; Weltert, Luca; Scaffa, Raffaele; Wolf, Lorenzo Guerrieri; Maselli, Daniele; Mauro, Michele Di

doi:10.1016/j.jtcvs.2016.08.063

Cited by 17 publications

(5 citation statements)

References 19 publications

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“…In conclusion, although larger sizes, namely, 23 mm and 25 mm, show a performance comparable to the other commonly available bioprostheses, when a smaller size is needed, it might be useful to choose a different type of valve, unless one is sure that no PPM will be present, even of moderate grade. The use of the LivaNova Mitroflow valve should be avoided for size 19 and strictly limited for size 21 [25], mainly because the achieving a no-PPM situation is unlikely. Alternatively, surgical enlargement of the aortic annulus root system should be considered and applied, especially in patients with longer life expectancy.…”

Section: Commentmentioning

confidence: 99%

An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses

Bassano

Gislao

Bovio

et al. 2018

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses

Bassano

Gislao

Bovio

et al. 2018

The Annals of Thoracic Surgery

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“…As an alternative technique for small aortic annulus treatment, despite the unavoidable additional risks related to lifelong anticoagulant therapy, AVR with a small size bileaflet mechanical prosthesis even in older patients has been proposed. 24…”

Section: Discussionmentioning

confidence: 99%

“…6 As an alternative technique for small aortic annulus treatment, despite the unavoidable additional risks related to lifelong anticoagulant therapy, AVR with a small size bileaflet mechanical prosthesis even in older patients has been proposed. 24 Recently sutureless and rapid-deployment bioprostheses have become available, thus expanding the "toolbox" of the cardiac surgeon. In this modified and evolving scenario, the choice of the appropriate prosthesis is crucial, in order to match the design characteristics and hemodynamic properties of the selected prosthesis to the clinical needs and characteristics of the patient.…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Replacement in Elderly Patients With Small Aortic Annulus: Results With Three Different Bioprostheses

Chiariello

Bruno

Villa

et al. 2019

Innovations�(Phila)

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Objectives Aortic valve replacement (AVR) in patients with small aortic annulus (diameter ≤21 mm) is considered a challenging scenario because of technical aspects and the high risk of patient-prosthesis mismatch (PPM). The choice of the appropriate prosthesis is crucial, and at the moment, an ideal device has yet to be identified. We compare clinical and hemodynamic results after AVR with three bioprostheses with different design and characteristics. Methods We retrospectively evaluated 76 consecutive patients from two cardiac surgery centers who underwent AVR (Trifecta = 24; Edwards INTUITY Elite valve system = 26, and Perceval = 26) for severe aortic stenosis between 2013 and 2017. Patients selected were older than 75 years and with an annulus diameter ≤21 mm at preoperative echocardiogram. Reinterventions and combined procedures were excluded. Minimally invasive AVR was performed in 44 (57.8%) patients. Telephonic interview was obtained at 2.9 ± 0.5 years and echocardiographic follow-up at 2.2 ± 0.8 years. Results Clinical outcome was similar in the three groups. At follow-up, Trifecta patients presented significantly higher peak and mean transprosthetic pressure gradients ( P = 0.04 and 0.01). Effective orifice area and left ventricular mass regression were comparable, although an advantage was observed in Perceval patients without reaching the statistical significance. Incidence of moderate ( P = 0.2) and severe PPM ( P = 0.7) was comparable. Conclusions Despite higher postoperative pressure gradients observed with the Trifecta valve, all three prostheses (Trifecta, Edwards INTUITY Elite, and Perceval) have proven to be reliable when implanted in small aortic annuli, with good clinical outcome and favorable left ventricular mass regression.

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“…Several authors reported a worrisome early degeneration of Mitroflow bioprosthesis, mainly for small sizes, likely for the absence of an effective antimineralization treatment in first models such as Mitroflow LXA [ 1 , 2 ]. ViV TAVI has been reported as an effective, fast, and less invasive treatment to overcome risks of redo operation mainly when surgical reoperation with a sutured or a sutureless prosthesis is contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy

et al. 2018

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Mitroflow aortic prosthesis dysfunction in case of complex vascular disease is considered a challenging scenario. Because of the high risk for surgical reoperation and the presence of chronic aortic dissection originated from a calcified Kommerel diverticulum, we considered to perform a transapical valve-in-valve transcatheter aortic valve implantation (TAVI) procedure. Myocardial ischemia is a dreadful complication reported in valve-in-valve TAVI procedures, mainly in patients with degenerated Mitroflow aortic bioprostheses. Because of the narrow shape of Valsalva sinuses and the short distance between Mitroflow annulus and left coronary ostium, to overcome the risk of possible Mitroflow leaflets displacement during TAVI expansion thus overlapping coronary ostia, we performed a preventive angioplasty. Then, we implanted a bare metal stent on the left main protruding in the aortic root. At 3 years follow-up the patient was in good clinical conditions.

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The fate of small-size pericardial heart valve prostheses in an older patient population

Abstract: Small-size Mitroflow pericardial valve prostheses have shown a worrisome incidence of SVD even in patients aged >70 years. Based on this experience we have discontinued their use.

Cited by 17 publications

References 19 publications

An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses

An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses

Aortic Valve Replacement in Elderly Patients With Small Aortic Annulus: Results With Three Different Bioprostheses

Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy

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