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Favorable Gradients with the Mitroflow Aortic Valve Prosthesis in Everyday Surgery
04 April 2011
19 October 2011
02 March 2012 (online)
Background The supra-annular Mitroflow valve has been implanted for over 20 years, preferably in small aortic roots. Early outcomes and gradients in unselected elderly patients receiving aortic valve surgery are reported in this study.
Methods Mitroflow valves were implanted in 190 consecutive patients (70% females). Mean age was 75.6 ± 5.5 years, body mass index was 28.2 ± 5.3 kg/m2, and logistic EuroSCORE 17.8 ± 16.5%. There were 170 single, 17 double, and 3 triple valve procedures. Of all, 46.8% of surgeries were performed with coronary artery bypass grafting and 39.5% were performed with isolated aortic valve replacement (AVR). Rates of redo and endocarditic cases were 14.2 and 4.7%.
Results The 19-mm (n = 14), 21-mm (n = 135), and 23-mm (n = 41) valves showed mean gradients of 16.1 ± 7.4 mm Hg, 15.8 ± 7.1 mm Hg, and 11.6 ± 4.1 mm Hg, respectively, before discharge. Maximum gradients were 27.5 ± 13.0, 28.4 ± 12.6, and 21.6 ± 7.6 mm Hg, respectively. Correlation between gradients and sizes was significant. In-hospital mortality was 12.6% overall (6.7% in isolated AVR). The rate of valve-related events was low (mild paravalvular leakage 2.1%, neurologic 3.2%, bleeding 3.2%, atrioventricular block 4.2%, no thrombosis).
Conclusion The Mitroflow valve can be safely implanted in elderly patients undergoing advanced surgical procedures. Gradients were acceptably low even in the smallest valves.
- 1 Funder JA, Frost MW, Ringgaard S , et al. In-vivo blood velocity and velocity gradient profiles downstream of stented and stentless aortic heart valves. J Heart Valve Dis 2010; 19 (3) 292-303
- 2 Gonzalez-Juanatey JR, Garcia-Bengoechea JB, Garcia-Acuna JM , et al. The influence of the design on the medium to long-term hemodynamic behavior of 19 mm pericardial aortic valve prostheses. J Heart Valve Dis 1996; 5 (Suppl. 03) S317-S323
- 3 Yankah CA, Pasic M, Musci M , et al. Aortic valve replacement with the Mitroflow pericardial bioprosthesis: durability results up to 21 years. J Thorac Cardiovasc Surg 2008; 136 (3) 688-696
- 4 ISTHMUS Investigators. The Italian study on the Mitroflow postoperative results (ISTHMUS): a 20-year, multicentre evaluation of Mitroflow pericardial bioprosthesis. Eur J Cardiothorac Surg 2011; 39 (1) 18-26, discussion 26
- 5 Conte J, Weissman N, Dearani JA , et al. A North American, prospective, multicenter assessment of the Mitroflow aortic pericardial prosthesis. Ann Thorac Surg 2010; 90 (1) 144-152, e1–e3
- 6 Bleiziffer S, Eichinger WB, Hettich IM , et al. Hemodynamic characterization of the Sorin Mitroflow pericardial bioprosthesis at rest and exercise. J Heart Valve Dis 2009; 18 (1) 95-100
- 7 Jamieson WR, Koerfer R, Yankah CA , et al. Mitroflow aortic pericardial bioprosthesis—clinical performance. Eur J Cardiothorac Surg 2009; 36 (5) 818-824
- 8 Alvarez JR, Sierra J, Vega M , et al. Early calcification of the aortic Mitroflow pericardial bioprosthesis in the elderly. Interact Cardiovasc Thorac Surg 2009; 9 (5) 842-846
- 9 Lang RM, Bierig M, Devereux RB , et al; Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18 (12) 1440-1463
- 10 Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol 2000; 36 (4) 1131-1141
- 11 Benhameid O, Jamieson WR, Castella M , et al. CarboMedics Mitroflow pericardial aortic bioprosthesis - performance in patients aged 60 years and older after 15 years. Thorac Cardiovasc Surg 2008; 56 (4) 195-199
- 12 Vasan RS, Larson MG, Levy D. Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 1995; 91 (3) 734-740
- 13 García-Bengochea J, Sierra J, González-Juanatey JR , et al. Left ventricular mass regression after aortic valve replacement with the new Mitroflow 12A pericardial bioprosthesis. J Heart Valve Dis 2006; 15 (3) 446-451, discussion 451–452
- 14 Jamieson WR, Forgie WR, Hayden RI , et al. Hemodynamic performance of mitroflow aortic pericardial bioprosthesis - optimizing management for the small aortic annulus. Thorac Cardiovasc Surg 2010; 58 (2) 69-75
- 15 Kuehnel RU, Puchner R, Pohl A , et al. Characteristic resistance curves of aortic valve substitutes facilitate individualized decision for a particular type. Eur J Cardiothorac Surg 2005; 27 (3) 450-455, discussion 455
- 16 Stelfox HT, Ahmed SB, Ribeiro RA, Gettings EM, Pomerantsev E, Schmidt U. Hemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and stroke volume. Crit Care Med 2006; 34 (4) 1243-1246
- 17 de Simone G, Devereux RB, Daniels SR , et al; de SG. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation 1997; 95 (7) 1837-1843
- 18 Klaaborg KE, Egeblad H, Jakobsen CJ , et al. Transapical transcatheter treatment of a stenosed aortic valve bioprosthesis using the Edwards SAPIEN Transcatheter Heart Valve. Ann Thorac Surg 2009; 87 (6) 1943-1946
- 19 Gualis J, Castaño M, Gómez-Plana J, Callejo F. Mitroflow bioprosthesis stent deformation: a rare cause of early prosthetic stenosis. Heart Surg Forum 2009; 12 (2) E121-E122
- 20 Matsuzaki K, Unno H, Konishi T, Shigeta O. Left coronary ostial obstruction after aortic valve replacement with a supra-annular aortic valve. Jpn J Thorac Cardiovasc Surg 2006; 54 (5) 199-202