Occasional Single Beat Regurgitation Observed with the Medtronic Advantage Bileaflet Heart Valve

Intermittent incomplete closure of Medtronic Advantage aortic valve leaflets causes unnecessary reoperation

“…On clinical grounds, our patient, as well as those in Munich, is asymptomatic and the sudden decrease of diastolic pressure recorded concomitantly with the incomplete valve closure 1 does not seem to impair hemodynamic measurements. Moreover, the worldwide follow-up study, 4 as well as our own, 5 reported excellent outcomes in line with those of other long-established bileaflet valves in their early clinical stages.…”

“…This case report is in line with previous articles from Munich in which a total of 7 cases of intermittent regurgitation of a Medtronic Advantage aortic valve were observed. 1,2 Unfortunately, in our case there were several confounding factors that led us to believe the incomplete closure was caused by a thrombotic obstruction, and the patient underwent reoperation. First, there was a transient ischemic attack associated with a prolonged period of a low INR level, which was then followed by concomitant recent hemorrhoid surgery.…”

“…Second, the initial report or information on this phenomenon was not available yet. 1 Understanding the mechanism underlying this phenomenon is not an easy task because no hints other than its visualization are available to the investigators. Recently, Medtronic created an in vitro incomplete closure in a single size 23 Advantage valve using a flow testing system that was specifically developed to study this phenomenon.…”

“…Our case had some similarities with the Munich series, as the incomplete closure of the anterior leaflet generated a trivial regurgitation. 1,2 On the other hand, it also presented a delayed closure of the posterior leaflet, causing a 3ϩ regurgitation. The frequency of this latter phenomenon is difficult to assess because of its rare occurrence, which may require a long period of observation.…”

Clinical and echocardiographic assessment of the Medtronic Advantage aortic valve prosthesis: the Scandinavian multicentre, prospective study

“…[18][19][20] In this study, no patients presented with intermittent reduced excursion of one of the valve leaflets as reported in the brief communication from the Munich Heart Centre. 21 Study limitations were that 26% of the valves were implanted in the intra-annular position. Theoretically, this might reduce valve performance because the orifice available for blood flow is reduced by the prosthetic ring sewing cuff.…”