ProspeCtive, nOn-randoMized, MulticENter Clinical Evaluation of Edwards Pericardial Bioprostheses With a New Tissue Treatment Platform (COMMENCE)

Eligibility Criteria:

Inclusion Criteria:

   1. Is 18 years or older

   2. Provides written informed consent prior to trial procedures

   3. Agrees to attend all follow-up assessments for up to 5 years and is willing to comply
   with specified follow-up evaluations at clinical investigational sites that are
   participating in the COMMENCE trial and/or obtain the protocol-specified diagnostic
   tests at centers that are under the same IRB or the same healthcare system

   4. Diagnosed with aortic or mitral valve disease requiring valve replacement based on
   pre- operative evaluation

   5. Scheduled to undergo planned aortic or mitral valve replacement with or without
   concomitant bypass surgery

   6. Scheduled to undergo planned aortic valve replacement with or without resection and
   replacement of the ascending aorta from the sinotubular junction and without the need
   for circulatory arrest for hemi arch or arch replacement

Exclusion criteria:

A subject meeting any of the following criteria shall be excluded:

   1. Requires emergency surgery

   2. Requires planned multiple valve replacement/ repair (with the exception of mitral
   valve replacement with tricuspid valve repair)

   3. Has prior valve surgery, which included implant of a bioprosthetic valve, mechanical
   valve, or annuloplasty ring that will remain in situ

   4. Requires a surgical procedure outside of the cardiac area (e.g. vascular bypass)

   5. Requires surgical replacement of the aortic root

   6. Has active endocarditis/myocarditis or endocarditis/myocarditis within 3 months to the
   scheduled aortic or mitral valve replacement surgery

   7. Has renal insufficiency as determined by creatinine (S-Cr) level ≥ 2.5 mg/dL or end
   -stage renal disease requiring chronic dialysis at screening visit

   8. Has MRI or CT scan confirmed stroke, cerebrovascular accident (CVA) or transient
   ischemic attack (TIA) within 6 months (180 days) prior to planned valve surgery

   9. Has acute myocardial infarction (MI) within 30 days prior to planned valve surgery

10. Has presence of non-cardiac disease limiting life expectancy to less than 12 months

11. Diagnosed with hypertrophic obstructive cardiomyopathy (HOCM)

12. Diagnosed with abnormal calcium metabolism and hyperparathyroidism

13. Exhibits left ventricular ejection fraction ≤ 20% as validated by diagnostic procedure
   prior to planned valve surgery

14. Echocardiographic evidence of an intra-cardiac mass, thrombus, or vegetation

15. Hemodynamic or respiratory instability requiring inotropic support, mechanical
   circulatory support, or mechanical ventilation within 30 days prior to planned valve
   surgery

16. Documented leukopenia (WBC < 3.5x 10³/μL), acute anemia (Hgb < 10.0 gm/dL or 6 mmol/L)
   or thrombocytopenia (platelet count < 50x 10³/μL) accompanied by history of bleeding
   diathesis and coagulopathy

17. Has prior organ transplant or is currently an organ transplant candidate

18. Current or recent participation (within 6 weeks prior to surgery) in another drug or
   device trial

19. Was previously implanted with trial device (Model 11000A or Model 11000M)

20. Pregnant (female subject of childbearing potential only), lactating or planning to
   become pregnant during the duration of participation in trial

21. Currently incarcerated or unable to give voluntary informed consent

22. Documented history of substance (drug or alcohol) abuse within the last 5 years prior
   to implant

23. Requires concomitant left ventricular assist device (LVAD) placement