Die hämodynamische und klinische Funktion der Medtronic Mosaic Bioprothese in Aortenposition

Background: Study aim was to collect intermediate-term data of the Mosaic bioprosthesis in aortic position after implanting the first device worldwide in February 1994 in our hospital. Methods: The Mosaic bioprosthesis is a stented porcine aortic valve, which combines glutaraldehyde fixation with zero pressure and root pressure techniques and antimineralization treatment with amino oleic acid for improved hemodynamics and tissue durability. Included in a multicenter study, 100 patients (49 females) underwent aortic valve replacement with the Mosaic bioprosthesis between February 1994 and May 1999. Mean age at implant was 73.4 ± 7.3 years. Concomitant procedures were performed in 40.0%. Patients were followed-up within 30 days postoperative, after six months and at annual intervals. Mean follow-up was 3.8 years (range 0.1-7.1 years); total follow-up was 383.1 patient-years (pt-yr) and was 100% complete. Results: Early mortality (within 30 days) was 3.0%; late mortality was 4.6%/pt-yr, including a valve-related mortality of 0.6%/pt-yr. Freedom from event rates at seven years were 96.8% ± 1.8% for thromboembolic events, 97.2% ± 2.0% for thrombosed bioprosthesis, 96.6% ± 2.6% for structural valve deterioration, 98.2% ± 1.8% for nonstructural dysfunction, 95.9% ± 2.0% for antithromboembolic hemorrhage, 98.9% ± 1.1% for endocarditis and 93.9 % ± 3.2% for reoperation and explant. Mean systolic pressure gradient was 15.3 ± 6.7mmHg (21mm), 14.5 ± 5.7mmHg (23mm), 12.7 ± 4.1mmHg (25mm) and 13.0 ± 4.8mmHg (27mm) after one year; effective orifice area was 1.4 ± 0.4cm2 (21mm), 1.7 ± 0.4cm2 (23mm), 1.8 ± 0.4cm2 (25mm) and 2.6 ± 0.4cm2 (27mm); effective orifice area index was 0.8 ± 0.3cm2/m2 (21mm), 0.9 ± 0.2cm2/m2 (23mm), 0.9 ± 0.2cm2/m2 (25mm) and 1.3 ± 0.1cm2/m2 (27mm). Left ventricular mass index decreased significantly from 159.7 ± 56.8g/m2 to 137.3 ± 40.8g/m2 for all sizes after one year. Conclusions: Clinical and hemodynamic performance of the Mosaic bioprosthesis was highly satisfactory during the first seven years after clinical introduction.

Level thesis:degree_level

thesis.doctoral

Grantor dc:publisher

Ludwig-Maximilians-Universität

Year

2003

Author dc:creator

• Botzenhardt, Florian

Repository record source_url

https://edoc.ub.uni-muenchen.de/1437/

OAI identifier oai:identifier

oai:edoc.ub.uni-muenchen.de:1437