Should patients with Björk-Shiley valves undergo prophylactic replacement?

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Decision Analysis

Background:

• Björk-Shiley convexo-concave (CC) valves are prosthetic heart valves used in approximately 85,000 patients.
• These valves carry a risk of outlet strut fracture, leading to potentially fatal acute valve failure.
• The incidence of strut fracture varies based on valve characteristics and patient factors.

Purpose of the Study:

• To identify patients most likely to benefit from prophylactic reoperation of CC valves.
• To utilize decision analysis to guide recommendations for CC valve replacement.

Main Methods:

• Estimating strut fracture incidence stratified by valve opening angle, diameter, and location.
• Employing a Markov decision analysis model to compare life expectancy with and without prophylactic valve replacement.
• Incorporating patient age and operative mortality risk into the analysis.

Main Results:

• Prophylactic replacement is not beneficial for CC valves with low strut fracture risks.
• Most patients with high-risk CC valves (e.g., ≥29 mm, 70 degrees) benefit from prophylactic replacement, increasing life expectancy.
• For elderly patients or those with intermediate-risk valves, the decision hinges on operative mortality risk and patient age.

Conclusions:

• Prophylactic replacement is recommended for most patients with high-risk CC valves.
• Individualized assessment of operative mortality risk is essential for all patients considering CC valve replacement.
• Patient age and operative risk are critical factors in decision-making for intermediate-risk valves.