The EpicTM Mitral stented tissue valve with LinxTM anticalcification (AC) technology is indicated for patients requiring replacement of a diseased, damaged, or malfunctioning native mitral heart valve. It may also be used to replace a previously implanted prosthetic mitral valve.
Data suggest many patients with degenerative mitral valve disease do not receive state-of-the-art care.1 And while mitral valve repair is typically the treatment of choice to treat mitral valve dysfunction, it is not always feasible.
- Valve durability
- The valve’s expected hemodynamic performance
A bioprosthetic mitral valve may be a recommended option for patients with:
- A contraindication for anticoagulation therapy, or anticipated nonadherence or inability to regulate vitamin K antagonists2
- Chronic, severe mitral regurgitation (MR) who are undergoing another surgery such as coronary bypass or aortic valve replacement2
- Chronic, severe MR who have symptoms indicating NYHA Class III or IV2 Chronic, severe MR and left ventricular ejection fraction ≤ 30%2
- Advanced endocarditis3
- Ischemic mitral valve disease (IMR)—with treatment often including both revascularization and valve repair or replacement3
For patients 50-70 years of age, there is no clear consensus on choosing a mechanical vs tissue valve. Newer-generation tissue prostheses may show greater freedom from structural deterioration, often for older patients.2
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- Adams DH, et al. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010;31:1958–1967. doi:10.1093/eurheartj/ehq222.
- Nishimura RA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. Circulation. 2017;135(25):e1159-e1195. doi: 10.1161/CIR.0000000000000503.
- Mick SL, et al. Mitral valve repair vs replacement. Ann Cardiothorac Surg. 2015;4(3):230-237.
EPICTM/ EPICTM SUPRA STENTED PORCINE TISSUE VALVES
INDICATION FOR USE
The EpicTM valve is indicated for patients requiring replacement of a diseased, damaged, or malfunctioning native aortic and/or mitral heart valve. It may also be used as a replacement for a previously implanted aortic and/or mitral prosthetic heart valve. The EpicTM Supra valve is indicated for patients requiring replacement of a diseased, damaged, or malfunctioning native aortic heart valve. It may also be used as a replacement for a previously implanted aortic prosthetic heart valve.
- Valve size selection is based on the size of the recipient annulus, and for supra-annular aortic placement, the anatomy of the sinotubular space. Implantation of an inappropriately large bioprosthesis may result in stent deformation, valvular incompetence, and/or damage to the surrounding tissues. The use of an inappropriately small bioprosthesis may result in suboptimal hemodynamics. Use only the St. Jude MedicalTM Bioprosthetic Heart Valve Sizer Set Model B1000 with the Epic and Epic Supra valves.
- Accelerated deterioration due to calcific degeneration of the Epic and Epic Supra valve may occur in:
- children, adolescents, or young adults;
- patients with altered calcium metabolism (e.g., patients with hyperparathyroidism or chronic renal failure); or
- individuals requiring hemodialysis.
- For single use only. Do not reuse or resterilize. Attempts to resterilize the valve may result in valve malfunction, inadequate sterilization, or patient harm.
- Passage of a catheter or transvenous pacing lead through any bioprosthesis may damage the valve and is therefore not recommended.
- Do not use if:
- the valve has been dropped, damaged, or mishandled in any way, or if there is any sign of deterioration;
- the expiration date has elapsed;
- the tamper-evident container seal is damaged, broken, or missing, or if fluid is leaking from the packaging; or
- the storage solution does not completely cover the valve.
- The safety and effectiveness of the EpicTM and EpicTM Supra valves has not been established for the following specific populations:
- patients who are pregnant
- nursing mothers
- patients with chronic renal failure
- patients with aneurysmal aortic degenerative conditions (e.g., cystic medial necrosis, Marfan’s syndrome)
- patients with chronic endocarditis
- patients requiring pulmonic or tricuspid valve replacement
- children, adolescents, or young adults
- Sizers are supplied non-sterile, and must be cleaned and sterilized prior to each use. Do not use cracked, deformed, or damaged sizer set components.
- Do not pass the flanged portion of the valve replica sizing tool through the annulus.
- Do not place the non-sterile exterior of the valve container in the sterile field.
- Do not expose the valve to solutions other than the formaldehyde valve storage solution in which it was shipped, the sterile isotonic saline solution used during the rinsing procedure, or the sterile isotonic saline solution used to irrigate the valve.
- Do not add antibiotics to either the formaldehyde valve storage solution or the rinse solution.
- Do not apply antibiotics to the valve.
- Do not allow the valve tissue to dry. Place the valve in sterile isotonic saline rinse solution immediately upon removal from the valve storage solution. Once removed from this solution, the valve should be periodically irrigated during implantation.
- Do not use the valve if shipping temperature indicators on the product carton have turned red, or if the valve has been improperly stored in temperature conditions outside of the 5 °C to 25 °C range.
- Do not implant the valve without thoroughly rinsing as directed.
- Do not lacerate the valve tissue. If a valve is damaged, the valve must be explanted and replaced.
- Do not attempt to repair a valve. Damaged valves must not be used.
- Do not use cutting edge needles, unprotected forceps, or sharp instruments as they may cause structural damage to valve.
- Never handle the leaflet tissue.
- Position the mitral valve in a manner to avoid commissure obstruction of the left ventricular outflow tract, and minimize any potential of commissure contact with the ventricular wall.
- Position the aortic valve so that the stent posts do not obstruct the coronary ostia.
- Avoid prolonged contact with the formaldehyde storage solution. Immediately after contact, thoroughly flush any skin exposed to the solution with water. In case of contact with eyes, flush with water and seek appropriate medical care.
The clinical investigation of the Epic valve supports the safety and effectiveness of the Epic valve and the Epic Supra valve. Between January 2003 and March 2006, seven-hundred and sixty-two (762) subjects were implanted with 791 Epic Valve(s) at 19 investigational sites in the United States (U.S.), and three sites in Canada. Five-hundred and fifty-seven (557) subjects received isolated aortic replacement, 176 received isolated mitral replacement, and 29 received replacement of both the aortic and mitral valves. The cumulative follow-up for all subjects was 773.51 patient-years with a mean follow-up of 1.02 patient-years (s.d. = 0.71 patient-years, range 0 – 3.10 patient-years).
Potential Adverse Events
Adverse events potentially associated with the use of bioprosthesis heart valves (in alphabetical order) include:
- cardiac arrhythmias
- heart failure
- hemolytic anemia
- hemorrhage, anticoagulant/antiplatelet-related
- leak, transvalvular or paravalvular
- myocardial infarction
- nonstructural dysfunction (entrapment by pannus or suture, inappropriate sizing or positioning, or other)
- prosthesis regurgitation
- structural deterioration (calcification, leaflet tear, or other)
- valve thrombosis
It is possible that these complications could lead to:
- permanent disability