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DISCUSSION The patient described had parietal pericardial bovine bioprostheses in both the mitral and aortic valve positions for 77 months and during that period developed huge quantities of calcium on the cusps of the bioprosthesis in the aortic valve position and only small quantities of calcium on the cusps of the bioprosthesis in the mitral valve position. Because the closing pressure on the mitral bioprosthesis is usually about a third higher than that on the aortic bioprosthesis (peak left ventricular systolic pressure vs end-diastolic aortic pressure; normally approximately 120 vs 80 mm Hg), it might be expected that the degeneration of a bioprosthesis in the mitral position would be greater (more calcium and more tears) and more rapid than that of a bioprosthesis in the aortic position, but the opposite was the case in the patient described herein. Why might that be the case? Some possibilities include the following:

journal of thoracic and cardiovascular surgery

Is minimized extracorporeal circulation effective to reduce the need for red blood cell transfusion in coronary artery bypass grafting? Meta-analysis of randomized controlled trials