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Current status of the mechanical valve and bioprosthesis in Japan

Shigehiko Tokunaga1, Ryuji Tominaga

  • 1The Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan. shiget@heart.med.kyushu-u.ac.jp

Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs
|July 8, 2008
PubMed

Insights

The 2006 guidelines favor bioprosthetic valves for aortic valve replacement due to improved durability and patient factors. Mitral valve repair is increasingly preferred over replacement.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomedical Engineering

Background:

  • The American College of Cardiology/American Heart Association (ACC/AHA) revised valvular heart disease management guidelines in 2006.
  • Previous guidelines were established in 1998, necessitating an update based on new evidence and technologies.

Purpose of the Study:

  • To review the 2006 ACC/AHA guidelines for valvular heart disease management.
  • To compare current trends in mechanical valve versus bioprosthesis selection with previous practices.
  • To describe the current status of valvular heart disease treatment based on the new guidelines.

Main Methods:

  • Review of the 2006 ACC/AHA guidelines for valvular heart disease.
  • Comparative analysis of valve selection trends (mechanical vs. bioprosthesis) in aortic and mitral valve replacement between the US and Japan.
  • Examination of factors influencing valve choice, including patient age, warfarin therapy acceptance, and reoperation risks.

Main Results:

  • A trend towards bioprosthetic valves in aortic valve replacement (AVR) in the US, attributed to lower deterioration rates, decreased reoperation risks, older patient populations, reluctance for warfarin therapy, and observed survival benefits.
  • Increasing use of tissue valves in Japan, driven by an aging population and similar factors as in the US.
  • Continued preference for mechanical valves over bioprostheses for mitral valve replacement in both the US and Japan.
  • A significant increase in mitral valve repair cases compared to mitral valve replacement.

Conclusions:

  • Bioprosthetic valves are increasingly favored for AVR, supported by improved outcomes and patient considerations.
  • Patient-centered decision-making, involving thorough discussion of risks, benefits, and lifestyle implications, is crucial for selecting prosthetic valves.
  • Mitral valve repair is becoming a more common alternative to valve replacement.

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