Maladies cardiovasculaires et diagnostic

Comparison of the Clinical Outcomes and Hemodynamic Performance between the 19-Mm Mosaic and 19-Mm TrifectaTM Bioprosthesis

Abstract

Daisuke Yuji, Ikuo Katayama, Kenichoro Noguchi and Masashi Tanaka

Background: We evaluated and compared short- (≤ 3 months) and mid-term (≥ 4 months) clinical outcomes and hemodynamic performances of the 19-mm Mosaic® and 19-mm TrifectaTM bioprostheses for aortic valve replacement.
Methods: 193 patients underwent aortic valve replacement: 37 received the 19-mm Mosaic® prosthesis (Group M) and 12 received the 19-mm TrifectaTM prosthesis (Group T). Pre- and postoperative echocardiographic parameters and New York Heart Association classes were evaluated in both groups. Results: Baseline characteristics and preoperative echocardiographic parameters were similar between the groups. The New York Heart Association class improved in both groups. The mean left ventricular-aortic pressure gradient was 22.6 mmHg ± 8.4 mmHg in Group M and 15.0 mmHg ± 6.2 mmHg in Group T. The left ventricular mass index was 99.6 ± 27.6 g/m2 and 99.0 ± 20.0 g/m2 respectively, with significant improvements in both groups. Left ventricular mass index regression during the mid-term period showed no significant difference between the groups, despite a higher-pressure gradient and smaller effective orifice area index in the Mosaic® group. Patient-prosthesis mismatch occurred in 20 patients in the Mosaic® group, with no significant differences in the postoperative left ventricular mass indices and New York Heart Association classes between the patientprosthesis mismatch and no patient-prosthesis mismatch subgroups in the Mosaic® group.
Conclusion: Compared with the 19-mm TrifectaTM bioprosthesis, the 19-mm Mosaic® bioprosthesis showed similar satisfactory improvement in the New York Heart Association class grade and reduction in the left ventricular mass index, despite a higher-pressure gradient and smaller effective orifice area index.