Structural valve deterioration of bioprosthesis in the aortic position: A single‐center experience

Abstract

Background Aortic valve replacement (AVR) is one of the most common open‐heart surgical procedures. The durability of the tissue valve in the aortic position is crucial in AVR and transcatheter AVR. We reviewed structural valve deterioration using echocardiographic follow‐up in three types of surgical aortic tissue valves. Methods A retrospective analysis was conducted where hemodynamic deterioration was evaluated and compared using transthoracic echocardiography, including pressure gradients and effective orifice area. Kaplan–Meier analyses were used to summarize the time to failure. Results The study included 133 Trifecta, 156 Epic, and 321 Magna Ease valves. Seventy‐six percent (1941/2551) of patients had to be excluded due to insufficient echo data. Through univariate analysis, 34% (216/610) of valves met deterioration criteria after 24 months. Unadjusted survival curves showed a significant difference between valves (p ≤ .001), with a longer mean time to deterioration for the Magna Ease versus Trifecta and Epic of 68.9 versus 50.1 and 38.2 months, respectively. A Cox proportional hazard analysis found worse hazard ratios of 1.69 (p ≤ .04) and 2.4 (p ≤ .01) for Trifecta versus Magna and Epic versus Trifecta, respectively. Conclusion All three valve types demonstrated structural valve deterioration on echocardiographic follow‐up with significant differences in rate. The Magna Ease appeared to have the highest durability, and the Epic the lowest. Further investigation is warranted to confirm the results in a larger multicenter study.

Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves

“…The main mechanisms of thrombus formation are as follows: 1) Surface factors: When the xenograft materials come into contact with the blood, proteins, erythrocytes, and platelets in blood nonspecifically adhere to the surface, and adhered blood platelets release adenosine diphosphate, thromboxane A 2 , and other agonists, which trigger the generation of thrombin and activate the complement. Eventually, a platelet [ 19,57] Abrasion-related damage to the tissue, cusp tears, and mineralization [ 58,63] Yes Ionescu-Shiley Low Profile (ISLP) pericardial valve Stented Shiley Laboratories Lower height or profile [ 55] Cusp abrasion, para stent post tears, and calcification [ 59,64] Withdrawn from the market in 1987 Mitroflow Stented Mitroflow (Vancouver, B.C., Canada) Acetyl homopolymer with "low creep" properties; covered with a medical grade polyester fabric; leaflets on the outside of the orifice ring [ 19] ; SVD, calcification, and cusp tears [ 65,66] 2007 CE Permount Stented Edwards Lifesciences, Irvine, CA Neutralogic stress-free fixation with glutaraldehyde; anti-calcification technology (XenoLogiX); flexible and elastic Elgiloy with PTFE cloth [ 19] SVD, calcification, and cusp tears [ 67,68] 1991 for the aortic valve and 2000 for the mitral valve Magna Ease Stented Edwards Lifesciences, Irvine, CA A modified version of CE Perimount bioprosthesis; excellent hemodynamic performance; anti-calcification technology (Thermafix) [ 69] SVD (a 10-year incidence of severe SVD: 14%); patient-prosthesis mismatch (PPM, 4.39%) [ 70,71] 2003 Trifecta GT Stented Abbot, USA Linx TM anti-calcification treatment; Glide Technology; expansive, externally mounted leaflet design; good hemodynamic performance [ 72,73] ; low incidence of SVD Early valve thrombosis, cusp tears, or leaflet calcification [ 74] ; amyloid deposition [ 75] ; 4-7% rate of redo AVR due to SVD at the 5-year follow-up [74] 2011 Inspiris Resilia Stented Edwards Lifesciences, Irvine, CA Treatment of glycerolization; a novel sterilization dry storage technology [ 60] ; good hemodynamic performance to Magna Ease [ 76] Reduced calcification; improved longevity [ 77] 2017 Avalus Stented Medtronic, Minneapolis, MN Anti-calcification treatment (𝛼-amino oleic acid) [ 61] ; short stent post and large cuf;f plia...…”

Structural valve deterioration in surgically implanted aortic bioprostheses

“…3 In this issue of Journal of Cardiac Surgery, Hodgson and colleagues compare the durability in terms of SVD of three types of bioprostheses implanted in their hospital in 10 years: Magna Ease, Trifecta, and St. Jude Epic. 4 Out of 2551 patients who underwent bioprosthesis implantations, the data of 610 were analyzed due to the completeness of echocardiographic follow-up. The authors demonstrate that SVD is present in 34% of patients in the early stages of the bioprostheses lifespan, after a mean follow-up time of only 24 months.…”