Heart valve surgery

Progress in valve repair and replacement continued over the past year. Aortic valve repair for aortic insufficiency appears promising, and aortic decalcification may still be a useful alternative in certain cases of aortic stenosis. Mitral valve repair, well accepted for myxomatous valves, presents a challenge in ischemic disease. Balloon mitral valvotomy offers significant short-term hemodynamic improvement, but needs to be properly compared with surgical treatment of mitral stenosis. Although aortic valve replacement with homografts and pulmonary autografts yields excellent results, enthusiasm for the stentless porcine xenograft is increasing. Clinical results reported for the Carpentier-Edwards pericardial valve (Baxter Healthcare Corp., Edwards Div., Santa Ana, CA) and the Bjork-Shiley monostrut valve (Shiley Inc., Irvine, CA) are excellent. Acute endocarditis continues to be a challenging problem but early aggressive debridement appears to offer patients the best chance of cure, regardless of what valve replacement is used.