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Yokoyama Y, Sakurai Y, Kuno T, Takagi H, Fukuhara S. Externally mounted versus internally mounted leaflet aortic bovine pericardial bioprosthesis: meta-analysis. Gen Thorac Cardiovasc Surg 2023; 71:207-215. [PMID: 36598643 DOI: 10.1007/s11748-022-01904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent studies reported higher-than-expected rates of early structural valve degeneration (SVD) and/or reoperation of externally mounted leaflet aortic bioprosthesis compared with others. This meta-analysis aims to compare the outcomes of bioprostheses with externally versus internally mounted leaflet design in patients who underwent surgical aortic valve replacement (SAVR). METHODS MEDLINE and EMBASE were searched through November 2021 to identify comparative studies investigating outcomes following SAVR with either externally or internally mounted leaflet aortic bioprosthesis. Outcomes of interest were reoperation for SVD or any cause and all-cause mortality. RESULTS Our analysis included 15 observational studies that enrolled a total of 23,539 patients who underwent SAVR using externally mounted (n = 9338; 39.7%) or internally mounted leaflet (n = 14,201; 60.3%) bioprostheses. Externally mounted valves consisted of the Trifecta (Abbott, St Paul, MN) (n = 6146) and the Mitroflow (LivaNova, London, UK) (n = 3192), and all internally mounted valves were the Perimount (Edwards Lifesciences, Irvine, CA). Externally mounted valves compared with the Perimount were associated with higher reoperation rates for SVD [hazard ratio (HR) 3.55, 95% confidence interval (CI) 2.67-4.72; P < 0.001] and any cause (HR 9.36, 95% CI 3.70-23.67; P < 0.001). Furthermore, externally mounted valves demonstrated higher all-cause mortalities (HR 1.33, 95% CI 1.13-1.56; P < 0.001). CONCLUSIONS The present study summarizing updated evidence revealed higher reoperation rates and all-cause mortalities in patients with externally mounted leaflet aortic bioprostheses compared with those with internally mounted design. Choosing the right SAVR valve type is critical part of lifetime management of aortic valve disease.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WV, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY, 10467-2401, USA.
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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2
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Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
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Della Barbera M, Valente M, Basso C, Pettenazzo E, Thiene G. The pathology of early failure in Mitroflow pericardial valve bioprosthesis (12A/LX). Cardiovasc Pathol 2021; 55:107373. [PMID: 34333132 DOI: 10.1016/j.carpath.2021.107373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Limited mid-term durability of 12A/LX Mitroflow bioprosthesis has been reported. Aim of the study was to ascertain the pathologic substrates and possible mechanisms of structural valve deterioration in explants from animals and humans. METHODS Nine aortic 12A/LX Mitroflow bioprostheses preserved in hypotonic solution and three aortic 12A/LX bioprostheses, preserved in isotonic solution, were explanted from juvenile sheep, mean time from implant 95.66 ± 36.04 days and 132.33 ± 28.88 days from implant respectively. One stented unimplanted 12A/LX Mitroflow preserved in isotonic colution before glutaraldeyde fixation served as control. Ten aortic 12A/LX Mitroflow bioprostheses were explanted from humans because of severe dysfunction: five children, (3 females and 2 males, mean age 14.19 ± 4.77 years, range 11-21), 26 ± 8.24 months from implant and 5 adults (4 females and 1 male, mean age 57.4 ± 19.85 years, range 31-72), 64.4 ± 26.94 months from implant. X-ray, histology, and transmission electron microscopy were carried out as well as spectroscopy for calcium (Ca++) and phosphorus (P) content in human explants. RESULTS Explants, from both animals and humans, showed cusp folding and stiffness, with coarse calcific deposits at gross examination and X-ray. Severe collagen denaturation, plasma insudation and massive calcification, involving both collagen and cell debris, were observed microscopically. Mean Ca++ content of 183.27 ± 62.48 and P content of 94.35 ±33.76 mg/g dry weight was found in children and Ca++ content of 205.49 ± 2.23 and P content of 99.75 ± 0.11 mg/g dry weight in adults. Obstructive fibrous tissue overgrowth was detected in 6 human cases. CONCLUSIONS Collagen denaturation was observed in pericardial Mitroflow 12A/LX bioprosthesis with premature structural valve deterioration. Optimal collagen fixation and preservation as well as phospholipids reduction by removing cell debris, as employed in the novel CROWN PRT Mitroflow bioprosthesis, are expected to solve the flaw and achieve long-term durability.
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Affiliation(s)
- Mila Della Barbera
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy.
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Ochi A, Cheng K, Zhao B, Hardikar AA, Negishi K. Patient Risk Factors for Bioprosthetic Aortic Valve Degeneration: A Systematic Review and Meta-Analysis. Heart Lung Circ 2020; 29:668-678. [DOI: 10.1016/j.hlc.2019.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/22/2019] [Indexed: 11/26/2022]
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Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, Ruel M, Al-Atassi T, Dumont E, Mohammadi S, Bernier M, Pibarot P, Rodés-Cabau J. Aortic Stenosis and Small Aortic Annulus. Circulation 2019; 139:2685-2702. [DOI: 10.1161/circulationaha.118.038408] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Afonso B. Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Gabriela Tirado-Conte
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Francois Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Talal Al-Atassi
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Mathieu Bernier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
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7
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Chiariello GA, Bruno P, Villa E, Pasquini A, Pavone N, Cammertoni F, Mazza A, Colizzi C, Nesta M, Iafrancesco M, Perri G, Messina A, Troise G, Massetti M. Aortic Valve Replacement in Elderly Patients With Small Aortic Annulus: Results With Three Different Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:27-36. [DOI: 10.1177/1556984519826430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Giovanni A. Chiariello
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Annalisa Pasquini
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Andrea Mazza
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Christian Colizzi
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Mauro Iafrancesco
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Gianluigi Perri
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
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Moscarelli M, Fattouch K, Speziale G, Nasso G, Santarpino G, Gaudino M, Athanasiou T. A meta-analysis of the performance of small tissue versus mechanical aortic valve prostheses. Eur J Cardiothorac Surg 2019; 56:510-517. [DOI: 10.1093/ejcts/ezz056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Small aortic prosthetic valves have been associated with suboptimal performance due to patient–prosthesis mismatch (PPM). This meta-analysis compared the outcomes of patients with a small root who received tissue versus mechanical aortic valves.
METHODS
A systematic literature review identified 7 candidate studies; of these, 5 met the meta-analysis criteria. We analysed outcomes for a total of 680 patients (227 tissue valves and 453 mechanical valves) using random effects modelling. Each study was assessed for heterogeneity and quality. The primary end point was mortality at follow-up. Secondary end points included intraoperative and postoperative outcomes, the rate of PPM and left ventricle mass regression and major cardiac and prosthesis-related adverse events at follow-up.
RESULTS
There was no between-group difference in mortality at follow-up [incidence rate ratio 1, 95% confidence interval (CI) 0.50–2.01; P = 0.99]. The tissue group had a higher rate of PPM (odds ratio 17.19, 95% CI 8.6–25.78; P = 0.002) and significantly less reduction in ventricular mass (weighted mean difference 40.79, 95% CI 4.62–76.96; P = 0.02). There were no significant differences in the incidence of structural valve disease at follow-up compared to that in the mechanical valve group. There was also no between-group difference in aggregated adverse events at follow-up (P = 0.68).
CONCLUSIONS
Tissue and mechanical valves were associated with similar mortality rates; however, patients receiving tissue valves had a higher rate of PPM and significantly less left ventricle mass regression. These findings indicate that patients receiving small tissue valves may require closer clinical surveillance than those receiving mechanical valves.
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Affiliation(s)
- Marco Moscarelli
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, Paddington, London, UK
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Aasbjerg K, Mortensen PE, Nørgaard MA, Rytgaard HC, Gerds TA, Søgaard P, Torp-Pedersen C, Mortensen RN, Bagge BJ, Køber L, Nielsen PH. Comparison of Survival After Aortic Valve Replacement With Mitroflow or Perimount Prostheses. Semin Thorac Cardiovasc Surg 2019; 31:350-358. [DOI: 10.1053/j.semtcvs.2018.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/30/2018] [Indexed: 11/11/2022]
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10
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Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L, Dahl JS, Søgaard P, Nørgaard MA, Møller JE. Structural valve deterioration in the Mitroflow biological heart valve prosthesis. Eur J Cardiothorac Surg 2018; 53:136-142. [PMID: 29029140 DOI: 10.1093/ejcts/ezx321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Concern has been raised regarding the long-term durability of the Mitroflow biological heart valve prosthesis. Our aim was to assess the incidence of structural valve degeneration (SVD) for the Mitroflow bioprosthesis in a nationwide study in Denmark including all patients alive in Denmark who had received a Mitroflow aortic bioprosthesis since 2000. METHODS Patients alive in Denmark with a Mitroflow bioprosthesis implanted since January 2000 were invited to participate in a nationwide cross-sectional study with a predefined definition of SVD. Of 1552 patients, 861 patients had died and 47 patients had been reoperated with 40 reoperations due to SVD. The remaining 644 patients were invited for evaluation; 574 patients accepted and were evaluated for SVD. The incidence of SVD was calculated using competing risk regression analysis with death as the competing event. RESULTS A total of 173 patients were diagnosed with SVD by echocardiography. Of these, 64 (11%) patients had severe SVD and 109 (19%) patients moderate SVD. Severe SVD was associated with the age of the prosthesis and small prosthesis size [Size 21: hazard ratio (95% confidence interval, CI) 2.72 (0.97-8.56), P = 0.06; Size 19: 6.26 (1.63-24.06), P = 0.008]. The cumulative incidences of reoperation or severe SVD at Year 9 were 12.5% for Size 19, 7.6% for Size 21 and 3.1 (1.2-6.4)% for Size 23. Median survival in patients with prosthesis Sizes 23-29 was 6.4 (95% CI 5.7-7.0) years, with Size 21 it was 6.5 (95% CI 5.9-7.1) years and with Size 19 it was 6.9 (95% CI 5.7-8.2) years (P = 0.78). CONCLUSIONS The incidence of undetected severe SVD was as high as the incidence of operated SVD. The overall risk for SVD is high for the Mitroflow bioprosthesis, especially if the prosthesis is small and older than 5 years.
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Affiliation(s)
- Issa Farah Issa
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Per Hostrup Nielsen
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Lars Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Agge Nørgaard
- Department of Cardiology and Cardiothoracic and Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Chiariello GA, Villa E, Messina A, Mangini SM, Rozzi M, Dalla Tomba M, Leonzi O, Troise G. Mitroflow Aortic Bioprosthesis Failure in Type B Aortic Dissection: Preventive Left Main Stenting in Transapical Transcatheter Aortic Valve Implantation Strategy. Cardiol Res 2018; 9:133-135. [PMID: 29755634 PMCID: PMC5942246 DOI: 10.14740/cr666w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/08/2018] [Indexed: 11/11/2022] Open
Abstract
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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Affiliation(s)
- Giovanni Alfonso Chiariello
- Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy.,Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | - Emmanuel Villa
- Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | | | - Stefano Marwan Mangini
- Cardiovascular Sciences Department, Catholic University of The Sacred Heart, Rome, Italy.,Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
| | | | | | - Ornella Leonzi
- Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
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12
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An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses. Ann Thorac Surg 2018; 105:521-527. [DOI: 10.1016/j.athoracsur.2017.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/22/2022]
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13
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Chiariello GA, Villa E, Messina A, Dalla Tomba M, Cirillo M, Brunelli F, Mhagna Z, Troise G. Sutureless prosthesis for failed small Mitroflow valves: the Perceval-after-Mitroflow procedure†. Interact Cardiovasc Thorac Surg 2018; 26:865-868. [DOI: 10.1093/icvts/ivx434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giovanni A Chiariello
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Emmanuel Villa
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Antonio Messina
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Margherita Dalla Tomba
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Cirillo
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federico Brunelli
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Zean Mhagna
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiovascular Department, Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
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14
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Ius F, Schulz J, Roumieh M, Fleissner F, Ismail I, Tudorache I, Warnecke G, Martens A, Shrestha M, Boethig D, Haverich A, Cebotari S. Long-term results of the Mitroflow aortic pericardial bioprosthesis in over 800 patients: limited durability and mechanisms of dysfunction†. Eur J Cardiothorac Surg 2017; 52:264-271. [DOI: 10.1093/ejcts/ezx161] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/15/2017] [Indexed: 11/12/2022] Open
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15
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Balsam LB, DeAnda A. The Mitroflow aortic valve: A past, present, and future illuminated. J Thorac Cardiovasc Surg 2017; 153:40-42. [DOI: 10.1016/j.jtcvs.2016.10.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/28/2022]
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