The Carbomedics aortic heart valve prosthesis: a review

The Carbomedics bileaflet mechanical prosthesis was introduced in 1986 and until now more than 500,000 valves have been implanted. The aim of this study was to review the papers published on the Carbomedics aortic heart valve prosthesis. The Carbomedics prosthesis has a solid pyrolite carbon housing and flat leaflets of pyrolite carbon coated graphite that is impregnated with tungsten. The pyrolite carbon housing is reinforced by an outer stiffening ring composed of titanium which virtually eliminates the risk of leaflet escape. The design further enables valve rotation after implantation. The standard aortic valve prosthesis has the sewing cuff located at the outflow level of the valve cylinder. A high-performance valve, the Carbomedics TopHat valve for supraannular implantation, is a standard aortic valve prosthesis where the sewing cuff has been transferred to the inflow level of the valve cylinder. A 2 size increase in valve size can be achieved by using the TopHat valve which is very important in patient-prosthesis mismatch. With the recommended international normalised ratio (INR) level for the Carbomedics aortic heart valve prosthesis the rate of embolic and bleeding events are low. Thrombosis of a Carbomedics aortic heart valve prosthesis is rarely seen and is the result of inappropriate anticoagulation without pannus formation. The incidence of prosthetic endocarditis is very low and this is also the case for noninfectious paravalvular leakage necessitating reoperation. Intrinsic dysfunction and/or structural failure has never been reported. The total absence of intrinsic dysfunction and structural failure of the Carbomedics aortic valve prosthesis is a great advantage. Further the complication rate is very low. The TopHat, the supraannular version of this prosthesis, is a perfect solution in patient-prosthesis mismatch.