Management of Failed Bioprosthetic Aortic Valves: Mitigating Complications and Optimizing Outcomes

Table 2

Surgical prosthesis amenable to valve fracture.

	Make	Stented/Stentless	Leaflets	Fracture threshold (atm)	Valve sizes	ID (mm)	Profile height (mm)
CE magna	Edwards lifesciences	Stented	Internal	22–24
					19	18.0	14.0
					21	20.0	15.0
					23	22.0	16.0
					25	24.0	17.0
					27	26.0	18.0
					29	28.0	19.0
CE magna ease	Edwards lifesciences	Stented	Internal	18
					19	18.0	13.0
					21	20.0	14.0
					23	22.0	15.0
					25	24.0	16.0
					27	26.0	17.0
					29	28.0	18.0
Perimount 2800/2900	Edwards lifesciences	Stented	Internal	20
					19	18.0	14.0
					21	20.0	15.0
					23	22.0	16.0
					25	24.0	17.0
					27	26.0	18.0
					29	28.0	19.0
Mitroflow	Sorin group	Stented	External	12
					19	15.4	11.0
					21	17.3	13.0
					23	19.0	14.0
					25	21.0	15.0
					27	22.9	16.0
Mosaic	Medtronic	Stented	Internal	10
					19	17.5	13.5
					21	18.5	15.0
					23	20.5	16.0
					25	22.5	17.5
					27	24.0	18.5
					29	26.0	20.0
Epic	Abbott	Stented	Internal	8
					19	18.7	14.0
					21	20.8	15.0
					23	22.6	16.0
					25	24.5	17.0
					27	26.3	19.0

The Mosaic valve has been manufactured with two different materials and behaves differently during BVF depending on the material used to manufacture the frame. If the frame is made of Derlin, fracture occurs ∼10–12 atm. If comprised of the high-performance thermoplastic polyetheretherketone (PEEK) (a small amount in the Mosaic valve) it cannot be fractured but can me remodeled; continue to increase the inflation device pressure beyond 12 atm and at about 18 atm, the valve frame will begin to stretch. Inflate to ∼22 atm to achieve maximal expansion. Allen KB, Chhatriwalla AK, Saxon JT, et al. Bioprosthetic valve fracture: Technical insights from a multicenter study. J Thorac Cardiovasc Surg. 2019; 158 (5):1317–1328 e1311.