We reviewed the cases of 100 patients (mean age, 73 +/- 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 +/- 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 +/- 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred in 31 patients (5 valve-related). Actuarial survival rates at 5, 10, and 15 years were 74% +/- 5%, 50% +/- 6%, and 37% +/- 8%. The mean NYHA class in survivors was 1.4 +/- 0.6 (P < 0.0001). Thromboembolic episodes occurred in 4 patients, with an actuarial freedom at 15 years of 91% +/- 5%. No cases of endocarditis were observed. Four patients needed reoperation, 2 for structural failure, and 1 each for perivalvular leakage and valve thrombosis. Actuarial freedom from structural failure and from reoperation, respectively, was 93% +/- 5% and 91% +/- 5% at 15 years. Echocardiographic follow-up in 24 patients with 27-mm prostheses showed a mean gradient of 5 +/- 1.7 mmHg and an effective orifice area of 1.57 +/- 0.3 cm(2); in 16 patients with 29-mm prostheses, the mean gradient was 4.5 +/- 1.9 mmHg, and the effective orifice area, 1.63 +/- 0.4 cm(2). During nearly 17 years of follow-up, the Mosaic bioprosthesis has shown good overall clinical and hemodynamic performance after mitral valve replacement.

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

MILANO, Aldo Domenico;
2016-01-01

Abstract

We reviewed the cases of 100 patients (mean age, 73 +/- 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 +/- 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 +/- 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred in 31 patients (5 valve-related). Actuarial survival rates at 5, 10, and 15 years were 74% +/- 5%, 50% +/- 6%, and 37% +/- 8%. The mean NYHA class in survivors was 1.4 +/- 0.6 (P < 0.0001). Thromboembolic episodes occurred in 4 patients, with an actuarial freedom at 15 years of 91% +/- 5%. No cases of endocarditis were observed. Four patients needed reoperation, 2 for structural failure, and 1 each for perivalvular leakage and valve thrombosis. Actuarial freedom from structural failure and from reoperation, respectively, was 93% +/- 5% and 91% +/- 5% at 15 years. Echocardiographic follow-up in 24 patients with 27-mm prostheses showed a mean gradient of 5 +/- 1.7 mmHg and an effective orifice area of 1.57 +/- 0.3 cm(2); in 16 patients with 29-mm prostheses, the mean gradient was 4.5 +/- 1.9 mmHg, and the effective orifice area, 1.63 +/- 0.4 cm(2). During nearly 17 years of follow-up, the Mosaic bioprosthesis has shown good overall clinical and hemodynamic performance after mitral valve replacement.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11586/226328
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