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Modes of failure in explanted mitroflow pericardial valves
Jagdish Butany1, Tianshu Feng, Adriana Luk
1Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada. jagdish.butany@uhn.on.ca
The Annals of Thoracic Surgery
|September 28, 2011
Summary
Structural deterioration is common in Mitroflow pericardial valves (A12) after two years. Valve design may contribute to cusp tears and calcification, leading to bioprosthetic heart valve failure.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pathology
Background:
- Bioprosthetic heart valves are crucial for treating valvular disease.
- This study focuses on the first morphologic analysis of explanted Mitroflow pericardial valves (model A12).
- Understanding failure modes is essential for improving valve design and patient outcomes.
Purpose of the Study:
- To conduct a detailed morphologic analysis of explanted Mitroflow pericardial valves (model A12).
- To identify and discuss the primary modes of bioprosthetic heart valve failure.
- To investigate potential links between valve design and structural deterioration.
Main Methods:
- Examination of 12 explanted Mitroflow (A12) valves between 2001 and 2010.
- Gross and microscopic analysis for postimplantation changes including cusp tears, calcification, pannus, inflammation, and thrombus.
- Radiographic assessment for calcification and identification of causes for dysfunction.
Main Results:
- Structural deterioration observed in 7 of 12 (58%) valves, with para-stent post cusp tears (42%) and calcification (50%) being prominent.
- Valves explanted due to infective endocarditis or thrombotic vegetations occurred in 5 patients.
- Cusp thickening, collagen disruption, and pannus formation were common findings.
Conclusions:
- 100% of Mitroflow pericardial valves in place for over 2 years showed structural valve deterioration.
- High rates of cusp tears and calcification suggest design-related mechanical stress.
- Abrasion from cross-sutures and Dacron fabric at stent posts may contribute to valve failure.
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