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Bjork-Shiley convexo-concave valve: is a prophylactic re-replacement justified?
G M Actis Dato1, P Centofanti, A Actis Dato
1Division of Cardiac Surgery, University of Turin, Italy.
The Journal of Cardiovascular Surgery
|July 21, 1999
Summary
The Bjork-Shiley convexo-concave valve had a 10-year survival of 71.4%, with most deaths valve-related but no fractures. Prophylactic replacement is not recommended due to reoperation risks.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Cardiology
Background:
- The Bjork-Shiley convexo-concave (BS-CC) valve was designed to improve hemodynamics and reduce thromboembolism compared to earlier models.
- Approximately 86,000 BS-CC valves were implanted between 1979 and 1986, with a subset experiencing intrinsic dysfunction leading to sudden death.
Purpose of the Study:
- To evaluate the long-term outcomes and complications associated with Bjork-Shiley convexo-concave heart valve implantation.
- To assess the necessity of prophylactic valve replacement in patients with BS-CC valves.
Main Methods:
- A cohort of 117 patients (125 BS-CC valves implanted) between 1979 and 1986 was retrospectively analyzed.
- Follow-up data, including survival rates (Kaplan-Meier), causes of death, and valve-related complications, were examined.
Main Results:
- Hospital mortality was 4.27%. Ten-year and 17-year survival rates were 71.4% and 54.7%, respectively.
- Most deaths were valve-related, though no instances of valve fracture were observed.
- One sudden death occurred in a high-risk patient; 30 deaths had unknown causes due to lack of autopsy.
Conclusions:
- Prophylactic replacement of BS-CC valves is not indicated due to higher reoperation risks compared to potential strut fracture.
- Autopsies are strongly recommended for all high-risk patients experiencing sudden death to determine the exact cause.