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Ionescu-Shiley valve failure. I: Experience with 125 standard-profile explants
V M Walley1, C A Keon, M Khalili
1Department of Pathology, University of Ottawa, Canada.
The Annals of Thoracic Surgery
|July 1, 1992
Summary
The Ionescu-Shiley valve shows high failure rates, particularly cusp tears causing insufficiency in aortic implants. This study details the pathology of these valve failures, offering insights into device performance.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pathology
Background:
- The Ionescu-Shiley valve is a widely used prosthetic device.
- Previous studies suggested patterns of Ionescu-Shiley valve failure.
- A comprehensive analysis of explanted valves is needed to confirm and extend these findings.
Purpose of the Study:
- To analyze the explantation reasons and failure modes of Ionescu-Shiley valves.
- To statistically compare failure rates and patterns between aortic and mitral valve positions.
- To detail the pathology associated with Ionescu-Shiley valve failure.
Main Methods:
- Review of 357 aortic and 190 mitral Ionescu-Shiley valve explants.
- Analysis of clinical and pathological data for explanted valves.
- Statistical comparison of failure modes (cusp tear, calcification) between aortic and mitral positions.
Main Results:
- Overall failure rates were 25.2% for aortic and 18.4% for mitral valves.
- Cusp tear with insufficiency was the primary explantation reason (19.1% aortic, 10.0% mitral).
- Aortic valves exhibited significantly more cusp tears and pre-tear wear than mitral valves.
Conclusions:
- Cusp tear is the predominant failure mode for Ionescu-Shiley valves, especially in the aortic position.
- The observed failure patterns, particularly the higher rate of cusp tears in aortic valves, differ from other pericardial valves.
- Detailed pathological examination of explanted valves provides crucial insights into device durability and failure mechanisms.