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
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 Crohnfs 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 (pƒ0.01). The mean pressure gradient also decreased significantly from 48.8}11.6mmHg to 23.9}9.32mmHg (pƒ0.01). 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 (pƒ0.05). 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)