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Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair

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Abstract

This study retrospectively evaluated the mid-term outcomes of surgical aortic valve replacement (SAVR) using a stented porcine aortic valve bioprosthesis (Mosaic; Medtronic Inc., Minneapolis, MN, USA) with concomitant mitral valve (MV) repair. From 1999 to 2014, 157 patients (median [interquartile range] age, 75 [70–79] years; 47% women) underwent SAVR with concomitant MV repair (SAVR + MV repair), and 1045 patients (median [interquartile range] age, 76 [70–80] years; 54% women) underwent SAVR only at 10 centers in Japan as part of the long-term multicenter Japan Mosaic valve (J-MOVE) study. The 5-year overall survival rate was 81.5% ± 4.1% in the SAVR + MV repair group and 85.1% ± 1.4% in the SAVR only group, and the 8-year overall survival rates were 75.2% ± 5.7% and 78.1% ± 2.1%, respectively. Cox proportional hazards analysis showed no significant difference in the survival rates between the two groups (hazard ratio, 0.87; 95% confidence interval, 0.54–1.40; P = 0.576). Among women with mild or moderate mitral regurgitation who were not receiving dialysis, those who underwent SAVR + MV repair, were aged > 75 years, and had a preoperative left ventricular ejection fraction of 30–75% tended to have a lower mortality risk. In conclusion, this subgroup analysis of the J-MOVE cohort showed relevant mid-term outcomes after SAVR + MV repair.

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Fig. 1
Fig. 2

Reproduced from Sugimori et al. ASAIO J 2021;67(Suppl 2):138. CI confidence interval, HR hazard ratio, LVEF left ventricular ejection fraction, MR mitral regurgitation, MV mitral valve, SAVR surgical aortic valve replacement

Fig. 3

Reproduced from Sugimori et al. ASAIO J 2021;67(Suppl 2):138. (a) Log relative risk is presented with patient age on the horizontal axis, adjusted for median preoperative LVEF of 64.8%, female sex, no ongoing kidney dialysis, and mild or moderate MR. (b) Log relative risk is presented with preoperative LVEF on the horizontal axis, adjusted for median age of 76 years, female sex, no ongoing kidney dialysis, and mild or moderate MR. LVEF left ventricular ejection fraction, MR mitral regurgitation, MV mitral valve, SAVR surgical aortic valve replacement

Fig. 4

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Ryan Chastain-Gross, Ph.D., and Angela Morben, D.V.M., E.L.S., from Edanz (https://jp.edanz.com/ac) and Elsevier Language Editing Services (https://webshop.elsevier.com/language-editing-services/language-editing) for editing a draft of this manuscript. We also thank Elsevier Webshop Illustration Services (https://webshop.elsevier.com/illustration-services) for drafting the tables, Andy Brandt, Ph.D., Aimee Talarski, Ph.D., and the American Journal Experts Illustration team (https://www.aje.com/jp/services/figures/) for drafting the figures, and Wyshena G, Ph.D. from American Journal Experts (https://www.aje.com) for final editing support. The reviewers’ comments helped to progress the research by initiating constructive discussions, including some rebuttals. This publication is dedicated to Taketo Hara, an old friend, and Toshio Nagai, a former patient.

Funding

This research received no specific grants from any funding source.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan

    Haruhiko Sugimori & Tatsuya Nakao

  2. Department of Cardiovascular Surgery, Midori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe, Hyogo, 651-2133, Japan

    Yukikatsu Okada

  3. Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13 Kosobe-Machi, Takatsuki, Osaka, 569-1192, Japan

    Yutaka Okita

  4. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hitoshi Yaku

  5. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshin-Machi, Suita, Osaka, 564-0018, Japan

    Junjiro Kobayashi

  6. Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4101, Japan

    Hideyuki Uesugi

  7. Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, 31-27 Omiya-Chyou, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan

    Shuichiro Takanashi

  8. Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-Chyou, Nakamura-ku, Nagoya, Aichi, 453-0046, Japan

    Toshiaki Ito

  9. Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan

    Tadaaki Koyama

  10. Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-0045, Japan

    Taichi Sakaguchi

  11. Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Kouji Yamamoto

  12. Department of Cardiovascular Surgery, Tottori University, 4-101 Koyama-Cho, Minami, Tottori, 680-8550, Japan

    Yasushi Yoshikawa

  13. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yoshiki Sawa

Authors
  1. Haruhiko Sugimori
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  2. Tatsuya Nakao
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  14. Yoshiki Sawa
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Contributions

HS was a major contributor in producing and proposing the theme of this subgroup analysis, writing the manuscript, and drafting the tables. YY was managed the J-MOVE study and contributed to the subgroup analysis of mild or moderate MR. KY helped with the statistical analysis and the drafting of the figures. TN, one of HS’s mentors, is the head of the Department of Cardiovascular Surgery at New Tokyo Hospital and the operating surgeon in the present study. Y Okada, Y Okita, JK, HU, TK, and TS provided constructive critical advice regarding the manuscript. Academic lectures by Y Okita, HY, ST, and TI were consulted in HS’s work. TN, Y Okada, Y Okita, HY, JK, HU, ST, TI, TK, TS, and YY were operating surgeons in the present study. TN, Y Okita, HY, JK, HU, ST, TI, TK, TS, and YS were the heads of the departments of the 10 centers included in the J-MOVE registry. Y Okada was the vice principal investigator of the J-MOVE study. YS was the principal investigator of the study and organized some of the academic lectures. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Haruhiko Sugimori.

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Conflict of interest

The authors declare that there are no conflicts of interest. Dr. Yoshiki Sawa is a member of the editorial board of Heart and Vessels.

Ethical approval

The main hospital’s Research Ethics Committee (reference number 0086) and the local institutional review board of each participating center reviewed and approved this study.

Consent to participate

The requirement for individual patient consent was waived because the data were collected retrospectively and anonymized.

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Sugimori, H., Nakao, T., Okada, Y. et al. Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair. Heart Vessels 39, 252–265 (2024). https://doi.org/10.1007/s00380-023-02325-x

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