Modes of the bioprosthetic valve failure of the porcine and pericardial valves in the mitral position

Abstract

OBJECTIVES This study was conducted to examine the incidence and modes of the bioprosthetic valve failure of the porcine valve in the mitral position and compare them with those of the pericardial valve. METHODS This study included 240 patients (116 men [48.3%]; mean age, 74.87 ± 6.61 years) who underwent mitral valve replacement using the St. Jude Medical Epic bioprosthesis (Epic) (N = 125) or Carpentier–Edwards Perimount (CEP) pericardial valve (N = 115) from January 2000 to December 2020. RESULTS The median clinical follow-up durations in the Epic and CEP groups were 54.5 months (range, 0–111 months) and 81.5 months (range, 0–194 months), respectively. Structural valve degeneration (SVD) was observed in 9 patients (7.2%) in the Epic group and 11 patients (9.6%) in the CEP group. The rates of freedom from SVD at 3, 5 and 7 years were 97.7%, 90.5% and 75.5% in the Epic group and 100.0%, 96.1% and 90.0% in the CEP group, respectively. SVD reoperation was performed for 7 patients (5.6%) in the Epic group and 6 patients (5.2%) in the CEP group. The rates of freedom from SVD reoperation at 3, 5 and 7 years were 97.7%, 90.5% and 75.5% in the Epic group and 100%, 96.1% and 90.0% in the CEP group, respectively. Epic SVD was predominantly due to leaflet tearing, whereas CEP SVD was predominantly due to leaflet calcification and adhesion to the subvalvular apparatus. CONCLUSIONS SVD of the porcine valve was predominantly due to leaflet tearing. The rate of reoperation for SVD was slightly higher for the porcine valve in the mitral position than for the pericardial valve at adjusted survival analysis.

Dynamic Echocardiographic Imaging of a Valve-in-Valve Mitral Prosthesis

“…Many studies on mortality in reoperation are based on a heterogeneous group of patients who differ in factors such as their initial valve operation and factors leading to reoperation. Based on one report, the documented mortality rate of bioprosthetic rereplacement for structural valve deterioration ranges from 4% to 20% in most series, depending on risk factors and patient status [ 9 , 10 ]. A number of studies evaluated mortality in reoperation as well as risk factors in determining those that are at high risk.…”

“…However, the majority are neither comprehensive nor large in sample size. One study identified advanced age, pulmonary disease, cognitive impairment, higher NYHA functional class, reduced ejection fraction, renal disease, multiple reoperation, coronary artery bypass graft (CABG) at time of previous valve operation, or those who require concurrent CABG at valve reoperation, as conferring increased risk of death at reoperation [ 4 , 9 ]. Also, the indication for reoperation, such as thrombosed valves or prosthetic valve endocarditis, also increases the risk of reoperation.…”

“…When bioprosthetic valves degenerate, reoperative valve replacement is still the current standard of care [ 9 – 12 ]. Transcatheter mitral valve replacement within a failed bioprosthetic valve is becoming a new viable option of secondary valve replacement in selected patients at high risk for open heart surgery/reoperation [ 6 , 7 ].…”

“…Transcatheter mitral valve replacement within a failed bioprosthetic valve is becoming a new viable option of secondary valve replacement in selected patients at high risk for open heart surgery/reoperation [ 6 , 7 ]. Currently, valve-in-valve replacement has been successfully performed in aortic, mitral, pulmonic, and tricuspid bioprostheses [ 8 , 9 ]. More studies are needed to evaluate long-term follow-up and outcomes, including quality of life of these percutaneous valve-in-valve replacement patients.…”

Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications

“…Although bioprosthetic mitral valve replacement (MVR) has been widely performed instead of mechanical MVR, structural valve deterioration could not be avoided. Especially for porcine valve, not only late valve failure but also early valve failure has been reported [ 1 ]. The mechanical valve, which guarantees long-term durability, remains a significant treatment option especially for young patients.…”