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Implanted size and structural valve deterioration in the Edwards Magna bioprosthesis
Douglas R Johnston1,2, Christopher Mehta1,2, S Christopher Malaisrie1,2
1Division of Cardiac Surgery, Northwestern Medicine and Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA.
Annals of Cardiothoracic Surgery
|June 6, 2024
Summary
Patient-prosthesis mismatch, indicated by higher post-operative valve gradients, increases the risk of reintervention after aortic valve replacement with the Magna bioprosthesis. Reintervention rates remain low at 15 years, but death is a competing risk.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Increasing use of bioprosthetic valves for aortic valve replacement (AVR) due to patient preference against anticoagulation and the rise of valve-in-valve transcatheter aortic valve replacement (VIV-TAVR).
- Patient-prosthesis mismatch (PPM) is a known adverse risk after AVR, but its impact on bioprosthetic valve durability requires further investigation.
Purpose of the Study:
- To evaluate the long-term durability of the Magna bioprosthesis after AVR.
- To assess the influence of valve size and hemodynamics on the durability of Magna bioprostheses.
Main Methods:
- Retrospective, single-center study of 2,100 patients undergoing surgical AVR with a Magna bioprosthesis (June 2004 - December 2022).
- Data collected from institutional registries, including perioperative information and long-term follow-up.
- Cumulative incidence of freedom from reintervention was estimated using competing risks analysis; Gray's test was used for group comparisons.
Main Results:
- Median follow-up was 5.8 years, with 116 reinterventions (74 explants, 42 VIV-TAVR).
- All-cause reintervention rates were 1.2% at 5 years, 4.5% at 10 years, and 11.7% at 15 years.
- Higher mean gradient at implant (indicating PPM) was associated with increased late reintervention (aHR: 1.016; P=0.0047). Smaller valve size was linked to worse survival but not reintervention.
Conclusions:
- The Magna bioprosthesis demonstrates low reintervention rates at 15 years, though death is a competing risk.
- Physiologically evident PPM, indicated by elevated post-operative valve gradients, is associated with a higher risk of reintervention.
- Further research is needed to understand the mechanisms of early stenosis in patients requiring reintervention.
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