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Background: The Mosaic bioprosthesis is a new generation stented porcine valve., Methods: Between May 1995 and April 1998, this valve was implanted in the aortic position in 98 patients (70 men; mean age, 69.2 years [34.2 to 83.6 years]). Preoperatively 35 patients were in New York Heart Association functional class 3 or 4. Fifty-nine patients underwent concomitant procedures. The mean duration at follow-up in January 1999 was 23.7 +/- 10.2 months (0.3 to 39.4 months) and totaled 193 patient-years. All but one survivor was in New York Heart Association class 1 or 2., Results: Early complications included 1 death, 3 reoperations for bleeding, greater than mild regurgitation (paravalvar) in 1 patient and thromboembolism in 4 patients. Late complications included four deaths, study-valve endocarditis in 3 patients, more than mild regurgitation or hemolysis in 2, and thromboembolism in 2 patients. Late follow-up echocardiography in all survivors showed a mean transaortic gradient of 13.6 +/- 6.7 mm Hg, and an aortic valve area of 1.80 +/- 0.61 cm2. Valve replacement was followed by a significant and sustained decrease in left ventricular mass for all valve sizes. There has been no primary structural valve failure., Conclusions: The early experience with the Mosaic valve in the aortic position has been promising.

Attempts at cardioscopy have been hampered by the inability to see through blood. We describe a new method of intracardiac fiberscopic visualization performed in sheep using cardiopulmonary bypass, asanguineous cardioplegic arrest, and replacement of intracardiac blood with a clear fluid. Right heart endoscopic visualization was achieved in 4 sheep using a method that could allow extrapolation to a percutaneous approach. Two of these animals were weaned successfully from cardiopulmonary bypass. Venting and flushing aspects of the procedure were of primary importance. Further development of this technique may open the way to percutaneous endoscopically guided intracardiac operations in humans.