Original articleAdult cardiacPathologic Evaluation of 28 Mitroflow Pericardial Valves: A 12-Year Experience
Section snippets
Material and Methods
After obtaining research ethics board approval, a review of pathology records was undertaken (January 2001 through July 2013). Demographic data (age at implant, sex, indication for implant and explant, implant duration, and blood and tissue cultures) were recorded. All specimens were fixed in 10% buffered formalin, photographed, and examined. All valves were examined for cusp tears (types I through IV), thickening, calcification (grades 0 through 4), pannus (grades 0 through 4), and thrombus 7,
Patient Demographics
Twenty-eight valves were available (Table 1), including those obtained from 2 patients explanted at post mortem and 1 patient explanted perioperatively because of paravalvular leak. Excluding the perioperative explant, and among the remaining 27 patients, with a mean age at implant of 72.2 ± 5.67 years (range, 60 to 81 years), there were 15 male patients (56%). The interval between index surgery and explantation was 4.5 ± 3.4 years (range, 3 months to 11 years). When we excluded those with IE,
Comment
Early models of the Mitroflow pericardial valve (model A11) were prone to failure in the aortic position in patients older than 70 years of age, with freedom from valve-related reoperation and SVD being 48% ± 5% and 39.2% ± 9.8% at 10 years, respectively 9, 10. In one study, 78% of patients were explanted because of SVD [3]. Early prosthesis failure was also reported in the mitral position, with re-replacement occurring at 55 months as a result of cusp tears and calcification [11]. The valve
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2022, Cardiovascular PathologyThe pathology of early failure in Mitroflow pericardial valve bioprosthesis (12A/LX)
2021, Cardiovascular PathologyCitation Excerpt :The group of Butany et al. detected commissural tearing and calcification [19-21], like those reported in Ionescu-Shiley and Hancock pericardial BPVs [22,23]. Despite observing histologically some collagen alterations, Butany et al. ascribed SVD to mechanical stress and defective valve design, probably because they did not employ transmission electron microscopy and could not see the phenomenon at higher magnification [19-21]. In conclusion, the short durability of 12A/LX Mitroflow BPV was due to a premature SVD and occurred both in humans and experimental large size animals with orthotopic implantation.
Intermediate-term outcomes of aortic valve replacement using a bioprosthesis with a novel tissue
2021, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :That NYHA class improved and remained stable for the 4 years of follow-up suggests that the clinical burden of undetected valve thrombosis, if it exists, must be low. Although less common a mode of failure than calcific SVD, recent reports have raised concern about early noncalcific SVD in pericardial aortic valves10,26 in the form of leaflet tears or dehiscence from the stent frame. Severe failures usually result in explanation, yet aortic regurgitation is expected to be the presenting finding in most cases.
Large Bioprosthetic Aortic Valve Thrombi on DOACs
2019, Heart Lung and CirculationCitation Excerpt :Both the Mitroflow (Sorin Group Inc, Vancouver, Canada) and the Carpentier-Edwards Perimount (Edwards Lifesciences, Irvine, CA, USA) pericardial valves, used in the aforementioned cases, have been available for over 30 years. Though there have been concerns raised of early valve deterioration in the former due to its structural design [31], Bourguignon et al. [32] found that of 2,659 patients implanted with the latter, valve lifespan approaches 20 years. As demonstrated by these cases, whilst both patients had strong risk factors for thrombus formation, accurate DOAC therapy (as demonstrated by raised APTT and PT) does not always prevent against bioprosthetic aortic valve thrombi.
An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses
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