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Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience

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Abstract

To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61–88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.

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References

  1. Minakata K, Tanaka S, Okawa Y, Shimamoto M, Kaneko T, Takahara Y, et al. Long-term outcome of the Carpentier-Edwards pericardial valve in the aortic position in Japanese patients. Circ J. 2014;78:882–9.

    Article  Google Scholar 

  2. Minami K, Zittermann A, Schulte-Eistrup S, Koertke H, Körfer R. Mitroflow synergy prostheses for aortic valve replacement: 19 years experience with 1516 patients. Ann Thorac Surg. 2005;80:1699–705.

    Article  Google Scholar 

  3. Borger MA, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel CM, David TE. Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis. 2006;15:49–55.

    PubMed  Google Scholar 

  4. Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119.

    Article  Google Scholar 

  5. Mykén PS, Bech-Hansen O. A 20 year experience of 1712 patients with the Biocor porcine bioprosthesis. J Thorac Cardiovasc Surg. 2009;137:76–81.

    Article  Google Scholar 

  6. Bourguignon T, Bouquiaux-Stablo AL, Loardi C, Mirza A, Candolfi P, Marchand M, et al. Very late outcomes for mitral valve replacement with the Carpentier-Edwards pericardial bioprosthesis: 25 year follow-up of 450 implantations. J Thorac Cardiovasc Surg. 2014;148:2004-2011.e1.

    Article  Google Scholar 

  7. Committee for Scientific Affairs, Ueda Y, Fujii Y, Udagawa H. Thoracic and cardiovascular surgery in Japan during 2006: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2008;56:365–88.

    Google Scholar 

  8. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, Okada M, Tangoku A, Doki Y, Endo S, et al. Thoracic and cardiovascular surgeries in Japan during 2017: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2020;68:414–49.

    Article  Google Scholar 

  9. Jamieson WR, Lewis CT, Sakwa MP, Cooley DA, Kshettry VR, Jones KW, et al. St Jude Medical Epic porcine bioprosthesis: results of the regulatory evaluation. J Thorac Cardiovasc Surg. 2011;141:1449–54.

    Article  Google Scholar 

  10. Kanda K, Kotegawa T, Kawatsu S, Takahashi G, Yoshioka I, Fujiwara H, et al. Early postoperative outcomes and evaluation of hemodynamics after mitral valve replacement with Epic mitral bioprosthesis. Kyobu Geka. 2015;68:961–6.

    PubMed  Google Scholar 

  11. Nakazato T, Hata H, Toda K, Miyagawa S, Yoshikawa Y, Saito S, et al. Midterm clinical outcomes of the St Jude Medical epic porcine bioprosthesis in the mitral position. Circ J. 2018;83:110–6.

    Article  Google Scholar 

  12. Pomerantzeff PM, Brandão CM, Albuquerque JM, Stolf NA, Grinberg M, Oliveira SA. Long-term follow up of the Biocor porcine bioprosthesis in the mitral position. J Heart Valve Dis. 2006;15:763–6.

    PubMed  Google Scholar 

  13. Mykén PS. Seventeen year experience with the St. Jude Medical biocor porcine bioprosthesis. J Heart Valve Dis. 2005;14:486–92.

    PubMed  Google Scholar 

  14. Firstenberg MS, Morehead AJ, Thomas JD, Smedira NG, Cosgrove DM, Marchand MA. Short-term hemodynamic performance of the mitral Carpentier-Edwards PERIMOUNT pericardial valve Carpentier-Edwards PERIMOUNT Investigators. Ann Thorac Surg. 2001;71:S285–8.

    Article  CAS  Google Scholar 

  15. Beute TJ, Goehler M, Parker J, Boeve T, Heiser J, Murphy E, et al. Long-term outcomes of mosaic versus perimount mitral replacements: 17 year follow-up of 940 implants. Ann Thorac Surg. 2020;110:508–15.

    Article  Google Scholar 

  16. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr. 2009;22:975–1014.

    Article  Google Scholar 

  17. Hwang HY, Kim YH, Kim KH, Kim KB, Ahn H. Patient-prosthesis mismatch after mitral valve replacement: a propensity score analysis. Ann Thorac Surg. 2016;101:1796–802.

    Article  Google Scholar 

  18. Hwang HY, Sohn SH, Jang MJ. Impact of prosthesis-patient mismatch on survival after mitral valve replacement: a meta-analysis. Thorac Cardiovasc Surg. 2019;67:538–45.

    Article  Google Scholar 

  19. De Das S, Nanjappa A, Morcos K, Aftab S, Butler J, Pathi V, et al. The effect of patient-prosthesis mismatch on survival after aortic and mitral valve replacement: a 10 year, single institution experience. J Cardiothorac Surg. 2019;14:214.

    Article  Google Scholar 

  20. Lee SH, Chang BC, Youn YN, Joo HC, Yoo KJ, Lee S. Impact of prosthesis-patient mismatch after mitral valve replacement in rheumatic population: does mitral position prosthesis-patient mismatch really exist? J Cardiothorac Surg. 2017;12:88.

    Article  Google Scholar 

  21. Evin M, Magne J, Grieve SM, Rieu R, Pibarot P. Characterization of effective orifice areas of mitral prosthetic heart valves: an in vitro study. J Heart Valve Dis. 2017;26:677–87.

    PubMed  Google Scholar 

  22. Guler N, Ozkara C, Akyol A. Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with posterior mitral leaflet preservation. Tex Heart Inst J. 2006;33:399–401.

    PubMed  PubMed Central  Google Scholar 

  23. Lee JZ, Tey KR, Mizyed A, Hennemeyer CT, Janardhanan R, Lotun K. Mitral valve replacement complicated by iatrogenic left ventricular outflow obstruction and paravalvular leak: case report and review of literature. BMC Cardiovasc Disord. 2015;15:119.

    Article  Google Scholar 

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Acknowledgements

We wish to thank Dr. Nagisa Morikawa of the Department of Cardiovascular Medicine, Kurume University School of Medicine, for assisting us with the statistical analysis and Editage (www.editage.jp) for English language editing.

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Correspondence to Takanori Kono or Kazuyoshi Takagi.

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Kono, T., Takagi, K., Saku, K. et al. Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience. J Artif Organs 24, 458–464 (2021). https://doi.org/10.1007/s10047-021-01262-8

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