Porcine versus bovine bioprosthetic valves in mitral position: does choice really matter?

BACKGROUND: Bioprosthetic valves are increasingly used for surgical mitral valve replacement (MVR). The long-term outcomes of bovine (BoMVR) vs porcine (PoMVR) remain an enigma regarding the durability. This study aims to examine the outcomes of BoMVR vs PoMVR. METHODS: A retrospective analysis of all bioprosthetic MVRs, with concomitant procedures, at a single tertiary referral institution from January 2005 to December 2008 was conducted. Procedures were classified as BoMVR or PoMVR. The age group was from 40 to 70 years. RESULTS: We identified 154 BoMVR patients and 120 PoMVR patients after matching the two groups with respect to age, sex, valve size and concomitant procedures. Kaplan-Meier survival analysis model was used for corresponding statistical analysis. Freedom from reoperation (all cause), freedom from non-structural valve deterioration, freedom from structural valve deterioration, freedom from heart failure and freedom from infective endocarditis were 96.4 ± 0.08, 97.1 ± 0.07, 96.4 ± 0.08%, 98.2 ± 0.07, and 98.6 ± 0.06% in PoMVR, respectively, and 92.6 ± 0.09, 91.6 ± 0.08, 90.6 ± 0.09, 94 ± 0.08, and 92.8 ± 0.08% in BoMVR groups, respectively, at the end of 10-year follow-up (mean follow up of 6.2 ± 2.3 years). Overall, 20 (12.9%) patients were lost to follow-up in the BoMVR and 15(12.5%) patients in the PoMVR groups for a global follow-up of 87.1%. CONCLUSIONS: For patients undergoing MVR with a bioprosthetic valve, the choice of PoMVR vs BoMVR favours more in favour of PoMVR as evidenced by the outcome results. Probably long-term follow-up with more patients might throw further light on the debatable topic.

Tansplantation of autologous bone marrow derived mesenchymal stem cells trans-epicardially in patients undergoing coronary bypass surgery.

BACKGROUND: Myocardial Infarction (MI) hampers cardiac performance by ventricular remodeling which is a major cause of heart failure or death. Conventional drug therapies like beta blockers, angiotensin-converting enzyme may delay remodeling but there is no single therapeutic regimen available that can prevent or reverse the process of myocardial injury. Interventional therapies and surgical procedures improve or normalize coronary blood flow greatly. Experimental data suggests that bone marrow derived Mesenchymal Stem Cells (MSCs) may contribute to the healing of Myocardial infarction. We present our findings on the use of bone marrow derived MSCs for Myocardial Infarction wherein the cells were injected in and around the infarct region epicardially during coronary bypass surgery. METHODS & MATERIALS: 31 patients selected to undergo Coronary Artery Bypass Graft (CABG) as a treatment option for myocardial infarction formed the subject matter of our study. One patient withdrew consent before receiving our therapy and was excluded from the study. 15 patients (all men, average age 57) formed the test arm who underwent CABG plus Bone Marrow Mesenchymal Stem Cells (BMMSCs) transplantation whereas another 15 patients underwent conventional CABG only (14 men and 1 woman, mean age 57) served as the control arm. The cell transplantation consisted of injecting BMMSCs in the border zone of the clearly visible infarcted area transepicardially. The absolute number of MSCs injected ranged between 3 million and 26 million cells. RESULTS: The data for change from baseline in the area of infarct was collected at 3 months and 6 months during the study and analyzed using paired t-tests. The mean percentage perfusion improvement from baseline in the area of infarct supplied by the Left Anterior Descending Artery (LAD) was higher in the cases (35.8%) as compared to the controls (11.3%) at 3 months post treatment (p value < 0.05). There were three cases of arrhythmia, and none of the adverse events recorded were due to the investigational product. Improvement in the ejection fraction was similar in the cases and controls. CONCLUSIONS: This study demonstrates that trans-epicardial uses of mesenchymal stem cells are very safe and feasible. Correction of perfusion defect is very encouraging. Larger studies using higher doses of mesenchymal stem cells may bring about better understanding.

Giant left ventricular aneurysm complicating silent inferoposterior myocardial infarction.

BACKGROUND: True ventricular aneurysm in the inferior location is rare. A 54-year-old male was evaluated for recurrent heart failure. METHOD: The echocardiogram showed large aneurysm arising from the inferoposterior wall of the left ventricle and severe mitral regurgitation. RESULTS: The coronary angiogram revealed occluded right coronary artery (RCA) in the mid segment. CONCLUSION: The patient underwent aneurysm repair and coronary artery bypass grafting to RCA.