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Twenty-five-year experience with the Björk-Shiley convexoconcave heart valve: a continuing clinical concern
William J Blot1, Michel A Ibrahim, Tom D Ivey
1International Epidemiology Institute, Rockville, MD, USA. blotw@iei.ws
Circulation
|June 2, 2005
Summary
Björk-Shiley convexoconcave (BSCC) valve fractures continue to occur, posing risks despite declining rates. Guidelines help identify patients who may benefit from prophylactic valve replacement surgery.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Prosthetic Heart Valves
Background:
- The Björk-Shiley convexoconcave (BSCC) prosthetic heart valve was first implanted in 1978.
- This review summarizes research on BSCC valve fracture, patient management, and clinical options 25 years post-implantation.
Observation:
- Outlet strut fractures (OSFs) have been reported in 633 BSCC valves (0.7%) as of December 2003.
- Fracture rates continue, with recent rates below 0.1% per year for 60-degree valves.
- OSF risk is influenced by valve characteristics (angle, size) and patient demographics (sex, age).
Findings:
- The risks associated with valve replacement surgery generally outweigh the risks of OSF.
- Individualized risk assessment comparing OSF probability to replacement risks is crucial.
- Guidelines have been developed to identify patients, primarily younger men, who might benefit from prophylactic reoperation.
Implications:
- Continued monitoring of BSCC patients is essential for risk assessment and guideline updates.
- Proactive management strategies are needed to address ongoing BSCC valve fracture risks.
- Informed clinical decision-making requires balancing fracture risks against surgical risks.
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