title: Long-Term Outcomes and Durability of the Mitroflow Aortic Bioprosthesis.
abstract: BACKGROUND
  This study aims to determine the incidence and causes of structural valve deterioration (SVD) among all models of Mitroflow bioprostheses (A12/LX/DL), as well as to define their long-term clinical and hemodynamic performance.
  
  
  RESULTS
  We retrospectively reviewed a series of 1023 patients who underwent aortic valve replacement with Mitroflow bioprostheses between 2001 and 2014. A small aortic root was found in 22.4% of patients. There were two cases of severe patient-prosthesis mismatch. Only 31 patients developed SVD. The rate of incidence was 8.1 cases per 1000 patient-years. Cumulative incidence of SVD was 1.4% and 3% at five and 10 years, respectively. Freedom from SVD was 97.4% and 88.2% at five and 10 years, respectively. Anticalcification phospholipid reduction treatment (PRT) for model DL was a protective factor for SVD. Multivariable analysis confirmed age <70 years and use of 19 mm valve as independent predictors of SVD. Cumulative survival was 76.6% at five years and 42.3% at 10 years (mean follow-up 3.8 ± 3.1 years). In multivariable analysis, neither the use of small aortic prosthesis (p = 0.18) nor the occurrence of SVD (p = 0.85) was found to be independent predictors of long-term survival.
  
  
  CONCLUSIONS
  Mitroflow valves demonstrate an acceptable rate of SVD and satisfactory long-term hemodynamic performance, particularly in patients with small aortic roots, age >70 years, and cases with severe left ventricular hypertrophy. PRT might contribute to improved long-term durability. doi: 10.1111/jocs.12726 (J Card Surg 2016;31:264-273).
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Velasco-García
authors.affiliation: Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Estévez-Cid
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Portela-Torron
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Herrera-Noreña
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008422:Materials Testing; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013997:Time Factors