title: Predictors of Survival and Modes of Failure After Mitroflow Aortic Valve Replacement in 1,003 Adults.
abstract: BACKGROUND
  Midterm outcomes are unknown for patients undergoing aortic valve replacement (AVR) with a Mitroflow bovine pericardial prosthesis (Sorin Group, Inc) and without anticalcification treatment. Recent reports warn of early senescence in younger adults.
  
  
  METHODS
  From January 2004 through December 2011, 1,003 adults underwent Mitroflow AVR. The mean follow-up time was 25.0 (standard deviation [20.6]) months (total, 2,060 patient-years; maximum, 9 years). The patients were stratified for analysis according to age at implantation: group A, <60 years (n = 63, 6.3%); group B, 60-69 years (n = 173, 17.2%); group C, 70-79 years (n = 432, 43.1%); and group D, 80 years or older (n = 335, 33.4%).
  
  
  RESULTS
  The mean age was 74.8 years (SD 9.8), and 609 patients (60.7%) were men. Aortic valve stenosis was present in 912 patients (90.9%), and 113 (11.3%) had severe aortic regurgitation. There were 27 (2.7%) early deaths, 15 of 431 (3.5%) underwent concomitant coronary artery bypass grafting while 12 of 572 (2.1%) did not (p = 0.18), and 151 patients (15.1%) died during follow-up. Nineteen AVRs (1.9%) required re-replacement through August 2013; 12 (63.2%) were associated with structural valve deterioration. The overall rates of freedom from valve-related reoperation at 3 and 5 years were 98.3% and 93.8%, respectively. Group A had the greatest number of reoperations (6/63; p < 0.001). The overall survival rates at 1 and 5 years were 91.2% and 67.3%, respectively. Independent predictors of mortality were poorer New York Heart Association functional class (hazard ratio [HR], 2.1; p < 0.001), atrial fibrillation (HR, 1.8; p = 0.002), and prior cardiac operation (HR, 1.8; p = 0.003).
  
  
  CONCLUSIONS
  Midterm follow-up shows acceptable hemodynamic performance of the Mitroflow biologic aortic valve prosthesis in selected patients 60 years old and older. Ongoing follow-up will be necessary to understand long-term performance and outcomes.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Anantha Narayanan
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: rakesh.m.suri@gmail.com.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Murat
authors.initials: M
authors.lastname: Ugur
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure