Comprehensive Echocardiographic Assessment of Normal Mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount Bioprostheses Early after Implantation

Background

Normal Doppler-derived hemodynamic data for mitral valve bioprostheses are limited.

Methods

To establish parameters for identifying normal function for each of the 3 types of bioprostheses examined, we conducted a comprehensive, retrospective, two-dimensional, and Doppler echocardiographic assessment of 179 patients who underwent implantation of the Medtronic Hancock II or the Medtronic Mosaic (Medtronic, Inc, Minneapolis, MN) porcine mitral valve bioprosthesis or the Carpentier-Edwards Perimount (Edwards Lifesciences LLC, Irvine, CA) bovine pericardial mitral valve bioprosthesis.

Results

All bioprostheses were normal by clinical examination, intraoperative transesophageal echocardiography, and postoperative transthoracic echocardiography. Regardless of valve type and body surface area, the pressure half-time was < 124 ms in all patients. Mean gradient < 9.5 mm Hg, mitral E velocity < 2.6 m/s, mitral valve prosthesis time-velocity integral < 69 cm, and ratio of the mitral valve prosthesis time-velocity integral to the left ventricular outflow tract time-velocity integral < 3.4 were recorded in nearly all patients.

Conclusion

These cutoff values (mean + 2 standard deviation) are specific, but not sensitive, for identifying mitral valve prosthesis dysfunction. Prostheses with hemodynamic values that are higher than these cutoff values are likely dysfunctional, but in select cases, mitral valve prosthesis dysfunction may be present even when hemodynamic values are lower than these thresholds.

Keywords: Doppler, Echocardiography, Mitral, Prosthesis

Abbreviations: CEP, Carpentier-Edwards Perimount, EOA, Effective orifice area, E velocity, Peak early mitral diastolic velocity, GOA, Geometric orifice area, HKII, Medtronic Hancock II, IEOA, Indexed EOA, MG, Mean gradient, MM, Medtronic Mosaic, PHT, Pressure half-time, PPI, Prosthesis performance index, PPM, Prosthesis-patient mismatch, SD, Standard deviation, TEE, Transesophageal echocardiography, TTE, Transthoracic echocardiography, TVI_LVOT, Left ventricular outflow tract time-velocity integral, TVI_MVP, Mitral valve prosthesis time-velocity integral