Key result
Small Mosaic bioprostheses show similar cardiac survival to larger sizes in AS with reduced LVEF.
Why the study?
The impact of a small-sized Mosaic porcine bioprosthesis on hemodynamic performance and outcomes in patients with AS and low LVEF required evaluation.
Does a small-sized Mosaic porcine bioprosthesis (≤ 21 mm) provide similar hemodynamic performance and clinical outcomes compared to a larger bioprosthesis (≥ 23 mm) in patients with aortic stenosis and LVEF < 50%?
Cohort (n=105)
Yes
Does a small-sized Mosaic porcine bioprosthesis (≤ 21 mm) provide similar hemodynamic performance and clinical outcomes compared to a larger bioprosthesis (≥ 23 mm) in patients with aortic stenosis and LVEF < 50%?
A small-sized Mosaic porcine bioprosthesis (≤ 21 mm) provides similar hemodynamic improvements and clinical outcomes as larger valves in patients with aortic stenosis and reduced LVEF.
Small Mosaic valves may be viable in low-LVEF AS; extends observational data but leaves open need for RCTs.
We evaluated impact of a small-sized Mosaic porcine bioprosthesis on hemodynamic performance and outcomes in patients with aortic stenosis (AS) and low left ventricular ejection fraction (LVEF) in a Japan multicenter cohort. Of 1,202 patients enrolled, 105 (8.7%) who had LVEF < 50% and AS underwent aortic valve replacement (AVR). Fifty-two patients received Mosaic porcine bioprosthesis ≤ 21 mm (S-AVR), and 53 received a bioprosthesis ≥ 23 mm (L-AVR). The median follow-up period was 3.1 [1.2, 5.1] years. At 5 years, LVEF significantly improved from median 41.2 [33.8, 45.9]% to 64.2 [49.8, 72.5]% in S-AVR (p < 0.001) and from median 43.2 [37.3, 46.8]% to 61.2 [47.2, 68.0]% in L-AVR (p < 0.001). The left ventricular mass index significantly decreased from median 158.4 [122.2, 194.9] to 110.0 [83.6, 129.4] gm/m in S-AVR (p < 0.001) and from median 169.8 [132.2, 203.6] to 109.6 [101.8, 132.4] gm/m in L-AVR (p < 0.001). There were no significant differences between S-AVR and L-AVR groups regarding freedom from cardiac death (93.1 ± 3.9% vs. 96.2 ± 3.8%; p = 0.119) and valve-related death (97.6 ± 2.4% vs. 100.0 ± 0.0%; p = 0.953). Clinical outcomes and improved hemodynamic performance were similar in both groups.
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Fukunaga et al. (2019) conducted a cohort in Aortic stenosis with low left ventricular ejection fraction (n=105). Mosaic porcine bioprosthesis ≤ 21 mm vs. Mosaic porcine bioprosthesis ≥ 23 mm was evaluated on Freedom from cardiac death (p=0.119). A small-sized Mosaic porcine bioprosthesis (≤21 mm) yielded similar freedom from cardiac death compared to larger sizes (≥23 mm) (93.1% vs 96.2%; p=0.119) in patients with AS and LVEF <50%.
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