Clinical and hemodynamic performance of the 19-mm medtronic mosaic bioprosthesis.
OBJECTIVE
The Medtronic Mosaic valve (MMV) is a latest generation supra-annular stented porcine valve, which combines a low-profile stent, leaflet fixation at zero pressure in a predilated aortic root, and amino-oleic acid anti-mineralization treatment for improved hemodynamics and durability. A study was conducted to evaluate the clinical and hemodynamic performances of the MMV in patients with a small aortic root (19 mm aortic annulus).


METHODS
Between 1998 and 2004, 81 consecutive patients (69 females, 12 males; mean age 78.0 +/- 5.5 years) underwent aortic valve replacement using the 19-mm MMV. Concomitant coronary artery bypass grafting was performed in 28 patients (29.2%), and mitral valve surgery in one patient (1.2%).


RESULTS
The 30-day mortality rate was 9.9% (eight deaths). Postoperative actuarial survival estimates were 90.1 +/- 3.3%, 78.5 +/- 4.6% and 69.1 +/- 5.5% at one month, one year and two years, respectively. After a mean follow up of 2.7 +/- 1.9 years, no cases of structural dysfunction, non-structural dysfunction or valve thrombosis were noted. Four ischemic cerebral complications (2.0% per patient-year (pt-yr)), five bleeding complications (2.0%/pt-yr) and two prosthetic valve infections (1.0%/pt-yr) were observed. No reoperation on a MMV was performed. Postoperatively, the mean systolic gradient was 23.4 +/- 7.0 mmHg, and the effective orifice area (EOA) 1.06 +/- 0.33 cm2. Valve prosthesis-patient mismatch (VP-PM) was moderate (indexed EOA > 0.65 cm2/m2 and < or = 0.85 cm2/m2) in 40 patients (49.4%), and severe (indexed EOA < or = 0.65 cm2/m2) in 41 (50.6%).


CONCLUSIONS
Although providing acceptable clinical results, implantation of the 19-mm MMV resulted in a high incidence of postoperative VP-PM. Hence, this valve should be reserved for patients in whom the projected indexed EOA calculated preoperatively is deemed acceptable, given the patient's clinical condition.
Department of Cardiothoracic Surgery, Hôpital Henri Mondor, Créteil, France. matthias.kirsch@hmn.aphp.fr
Matthias E W
ME
Kirsch
Boyan
B
Tzvetkov
Emmanuelle
E
Vermes
Bruno
B
Pouzet
Stéphane
S
Sauvat
Daniel
D
Loisance
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D002545:Brain Ischemia / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D015996:Survival Rate; D017725:Ventricular Pressure / Q000502:physiology