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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 April;41(2):181-6

lingua: Inglese

“Mosaic” medtronic bioprosthetic valve replacement. Clinical results and hemodynamical performance

Jasinski M. J., Kadziola Z., Keal R., Sosnowski A. W.

From the Cardiothoracic Surgery Department Glenfield General Hospital, Leicester, UK


Background. We ­report the mid-­term ­results of a pros­pec­tive ­trial of a new bio­pros­thet­ic ­valve. The Mosaic bio­pros­the­sis con­sists of por­cine aor­tic ­valve ­that has ­been cross linked ed in glu­ta­ral­de­hyde solu­tion ­under ­zero-pres­sure fix­a­tion and treat­ed ­with ­alpha ami­no ole­ic ­acid to ­reduce the poten­tial for cal­cifi­ca­tion.
Methods. Mosaic bio­pros­thet­ic ­valve replace­ment was per­formed in 67 con­sec­u­tive ­patients ­between January 1995 and August 1998. There ­were 37 ­patients hav­ing aor­tic ­valve replace­ment (AVR) and 30 hav­ing ­mitral ­valve replace­ment (MVR) who ­entered ­this ­study. The ­patients ­ age ­ranged 56 to 86 ­years (­mean 74.9); 38 ­were ­female and 29 ­were ­male; 44 ­were in ­NYHA ­grade 3 and 21 ­were ­NYHA ­grade 4. All ­mitral ­valve replace­ments ­were per­formed ­with ­total pres­er­va­tion of sub­val­vu­lar appa­ra­tus. Echocardiographic assess­ment of ­valve and LV func­tion ­were per­formed on 7th day, 6 ­months 1,2 and 3 ­years.
Results. There was no hos­pi­tal mor­tal­ity. 3 ­year sur­vi­val was 85.9±5.9% for AVR and 100% for MVR. Freedom ­from anti­throm­boem­bol­ic relat­ed hae­mor­rhage has ­been 96.7% for MVR and 91.9% for AVR. Freedom ­from the tran­sient neu­ro­log­i­cal ­event was 96.7±3.3% for MVR and 100% for AVR Freedom ­from struc­tu­ral ­valve fail­ure, per­ma­nent throm­boem­bo­lism, throm­bo­sis or endo­car­ditis has ­been 100% for ­both AVR and MVR. In AVR ­group ­left ven­tri­cle ­mass, ­left ven­tri­cle ­mass ­index sig­nif­i­cant­ly ­decreased, ­when car­diac ­index and effec­tive ori­fice ­area ­increased sig­nif­i­cant­ly dur­ing ­study peri­od. Transvalvular gra­di­ent did not ­change. In MVR ­group trans­val­vu­lar gra­di­ent, effec­tive ori­fice ­area and car­diac ­index did not ­change.
Conclusions. The ­valve was ­user friend­ly. The ear­ly ­results are ­very sat­is­fac­to­ry. Echocardiography meas­ure­ments ­after aor­tic ­valve replace­ment are show­ing ­very ­marked ­late post­op­er­a­tive remod­el­ling of ­left ven­tri­cle. After ­mitral ­valve replace­ment ­there ­were excep­tion­al­ly low trans­val­vu­lar gra­dients, no ­left ven­tri­cle out­flow ­tract obstruction.

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