| Early Experience with the 19-mm Medtronic Mosaic Porcine Bioprosthesis for Small Aortic Annuli |
(Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan)
| Hiroshi Kagawa |
Yoshimasa Sakamoto |
Hiroshi Okuyama |
| Shinichi Ishii |
Shingo Taguchi |
Kazuhiro Hashimoto |
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A study was conducted to evaluate the clinical and hemodynamic performance of the 19-mm Medtronic Mosaic Valve (MMV) in the aortic position, which is a third-generation stented porcine bioprosthesis. Between 2003 and 2006, 9 patients underwent AVR using the 19-mm MMV. None of the patients were suitable for a 19-mm Perimount bioprosthetic valve due to having a small annulus and sinotubular junction. The patients included 3 men and 6 women with a mean age of 73.2}4.97 years and mean body surface area of 1.35}0.11m2. Preoperatively, 8 patients were in New York Heart Association class II and 1 was in class III. The reason for surgery was aortic stenosis in 8 patients and aortic regurgitation due to infective endocarditis in 1 patient. Four patients had chronic renal failure and were on hemodialysis, while 1 patient had Crohnfs disease. Concomitant coronary artery bypass grafting was performed in 3 patients, and tricuspid valve annuloplasty was done in 1 patient. The follow-up period was 12.0}7.71 months. No deaths occurred, but there was 1 cerebral infarction. Postoperatively, the peak pressure gradient decreased from 81.3}32.7 to 40.3}16.3mmHg (p0.01). The mean pressure gradient also decreased significantly from 48.8}11.6mmHg to 23.9}9.32mmHg (p0.01). Left ventricular end-diastolic diameter was 47.9}3.82mm preoperatively and 45.1}7.53mm postoperatively, showing no significant change. The left ventricular mass index also improved from 217.3}46.9 to 160}54.9g/m2 (p0.05). The ejection fraction was 72.0}8.93% preoperatively and 67.6}6.37% postoperatively, showing no difference. Although the postoperative indexed effective orifice area (EOAI) was 0.90}0.11cm2/m2, mild patient-prosthesis mismatch (EOAI 0.77cm2/m2) was noted in 1 patient. In conclusion, the early clinical and hemodynamic performance of the 19-mm MMV in small elderly patients was acceptable.
@Jpn. J. Cardiovasc. Surg. 37: 1-5 (2008) |
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