Medtronic Mosaic vs Edwards Resiia?

[jhusker2]

Hello- Please allow me to preface this topic that I'm not wanting a debate regarding tissue vs mechanical. I realize that there are lot of conversations (or should I say biased opinions) on this subject already and I believe it is a 'personal' decision for choosing a particular valve type over another. That said, I'm merely looking for additional feedback from those that have received or can provide additional insight regarding the Medtronic Mosaic or Edwards Resilia valves? Unfortunately, I have found limited information via the web for either one. Thanks in advance!

 

[nobog]

Not sure what you are looking for, the Mosaic is a porcine valve and the Edwards is a bovine (pericardial valve). The Mosaic has a large variation in EOA, like most porcine valves. The Edwards is "TAVI ready" if that's of interest to you. I don't know your personal details (age, condition, history) but I would get in order;
1) a mechanical valve (I know you said this is not a T vs M valve post)
2) a porcine valve - they tend to be stable with good durability
3) although superior hemodynamics compared to a porcine valve, durability may not be on par with a porcine valve.

 

[pellicle]

That said, I'm merely looking for additional feedback from those that have received or can provide additional insight regarding the Medtronic Mosaic or Edwards Resilia valves?

what sort of feedback are you looking for? Also, I would ask you to consider what sort of "insight" a patient who gets a valve will have on the valve other than its the team they backed?

Seriously, from my perspective the question is unclear, and I'm just hoping that by clarifying it you'll get more of what your after.

Me (not having had either) from what I see, the Resilia is the better choice of those two

 

[tom in MO]

Hello- Please allow me to preface this topic that I'm not wanting a debate regarding tissue vs mechanical. I realize that there are lot of conversations (or should I say biased opinions) on this subject already and I believe it is a 'personal' decision for choosing a particular valve type over another. That said, I'm merely looking for additional feedback from those that have received or can provide additional insight regarding the Medtronic Mosaic or Edwards Resilia valves? Unfortunately, I have found limited information via the web for either one. Thanks in advance!

Most of us don't pick the valve, but let the surgeon do it. I asked my surgeon about what he'd install and he said St. Jude, I then asked about OnyX and he said he didn't use it but if I wanted it, he'd give it to me. When asked why he doesn't use it, he said he's used St. Jude for years and it has a robust track record. The hospital stocks one type of valve in various sizes for emergency replacements and it's the St. Jude.

A patient doesn't have much "feedback" to give, they are either alive or not. The valve operates w/o patient interactions. Most post surgery problems are not related to the model of valve.

 

[vitdoc]

Your question is simply what is the best valve between the two valves you have mentioned. I don't think there is anyone on earth who has a definitive answer. One can look at the current track records or make predictions based on similar valves but still this is a lot of guess work.
Ultimately at this stage of knowledge the choice is between mechanical or tissue. If one particular tissue valve was clearly superior than everyone would be using it. Currently as far as tissue valves go not the case. Noborg who works in the valve industry probably has the best take on your choices. The TAVR issue should be looked into further. That may be the deciding factor if there is a difference between the two on the ease or ability to perform a TAVR later.
Good luck.

 

[jhusker2]

Thank you for the responses. I'll add some more intricate details that might provide some additional clarification to what I'm asking.

- I currently have an Edward Bovine Mitral valve (Magna Ease) and it has lasted 12 yrs. It was also conveyed to me that the valve would probably only last 10-15 yrs, which I was okay with that choice due to my personal situation.
- I am strongly considering the Mitris Resilia valve this time around, however my surgeon alluded to the fact that I should entertain the Medtronic Mosaic porcine valve due to its durability in the mitral position, but did state that because both are considered next generation valves, there just isn't enough data to know which would be the better choice at this point. That said, I am looking for feedback for those that have experience with either valve along with why they chose that particular valve, e.g, recommended by the surgeon, trial data, etc.
- It's Also worth mentioning that I was given the opportunity to take a tour of Edwards facilities in CA, met the CEO, and even met the 2 individuals that made my implanted valve. It was a very humbling experience and the folks at Edwards were definitely a class act, however that doesn't mean I am choosing my 2nd valve because of that.

 

[pellicle]

but did state that because both are considered next generation valves

there's the key point. I see no evidence for significant differences in new valves vs the previous gen. Indeed the new valves seem to actually undertake shorter testing. Keen to get the little piggies to market I suppose.

That's the best data I can give you and I stick with my prior view (being what it is, a patient, who has an interest in the field but has a mechanical valve and thus no concerns about SVD).

You haven't mentioned your age, so I can't comment further on that, but I'm sure you now all the facts and are making your own decision based on that.

Best Wishes

 

[erricojj]

Here are some resources describing various aspects of the Edwards Inspirus Resilia aortic valve...

Long-term durability of a new surgical aortic valve: A 1 billion cycle in vitro study - ScienceDirect

This study is still in enrollment and will not complete until 2026-27. They are seeking 50 patients with failing aortic Inspirus Resilia valves who are undergoing Valve-in-Valve replacements. The protocol goes up to 25 mm valves only.
INSPIRIS RESILIA Aortic Valve, Valve-in-Valve Surveillance Study (INVIVITY)

Early Outcomes of Edwards INSPIRIS RESILIA Valve in Clinical Practice

FDA - SUMMARY OF SAFETY AND EFFECTIVENESS DATA (SSED)

Brief Summary: Prospective, open-label, multicenter, European registry with a follow-up of 5 years to assess the clinical outcomes of patients younger than 60 years who undergo surgical AVR with the INSPIRIS RESILIA Aortic Valve™.
Inspirus Resilia Durability Registry (INDURE)

Device profile of the Inspiris Resilia valve for aortic valve replacement: overview of its safety and efficacy

 

[tom in MO]

If you got 12 years out of a valve that was supposed to last 10-15, I'd stick with that company. You already know your body chemistry is compatible with their product. On top of that you met the team behind the valve and they were impressive...that's good karma

 

[nobog]

^^^^ A couple comments of the above study: (ScienceDirect)

1. Many tissue valves will go to 1 billion cycle in-vitro - what's not said is what the standard deviation for failure is due to the extremely small sample size.
2. The hydrodynamic data is next to useless, the industry and grad students love to do studies like this as it gives them a paper to write.
3. PIV (particle image velocimetry) is absolutely worthless, again it gives the grad students something to do, ANY reasonably functioning tissue valve will show a central jet - you look at the pretty picture and go "OK"

 

[pellicle]

Many tissue valves will go to 1 billion cycle in-vitro - what's not said is what the standard deviation for failure is due to the extremely small sample size.

I bang on about the miserable use if statistics in Medical journals, I'm pretty sure most people can't articulate what a standard deviation is.
Then there is the Elvis factor at work compounded by the sheer terror most first timers appear to experencing when making these choices. Its almost a fog which they suddenly can no longer see through.

See through time I mean, see past next year, see into 10 years from now, 20 years from now, 30 years from now. If you're under 40 those things are expectable dates statistically speaking.

I see time and time again people here describing very unenviable positions they are in because they took a path at the start (such as the Ross) and its left them with two stuffed valves and a bleak outlook at 50.