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Thrombectomy of the Björk-Shiley prosthetic valve revisited: long-term results
C G Montero1, N Mula, R Brugos
1Cardiovascular Surgery, Clinica Puerta de Hierro, Madrid, Spain.
Insights
Thrombotic obstruction of Björk-Shiley valves can be fatal. Simple thrombectomy and disc rotation may be a preferable alternative to valve replacement in select patients, avoiding high mortality risks.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Björk-Shiley prosthetic valve thrombosis is a severe complication.
- Valve replacement carries a high mortality risk.
Purpose of the Study:
- To evaluate thrombectomy and disc rotation as an alternative to valve replacement for thrombotic obstruction.
- To assess the efficacy and safety of this less invasive approach.
Main Methods:
- Review of 12 cases of Björk-Shiley valve thrombotic occlusion.
- Performance of simple thrombectomy and disc rotation, often via a bicameral approach.
Main Results:
- Thrombectomy and disc rotation proved effective in managing thrombotic obstruction.
- This method was successful even in mitral valve cases.
- The procedure was associated with a lower risk profile compared to replacement.
Conclusions:
- Simple thrombectomy and disc rotation is a viable and potentially preferable option for select patients with Björk-Shiley valve thrombosis.
- This approach may reduce the high mortality associated with valve replacement.
Abstract:
Thrombotic obstruction of the Björk-Shiley prosthetic valve is a catastrophic complication, often leading to a fatal outcome. Worldwide experience with the Björk-Shiley valve supports the need for long-term anticoagulation to prevent entrapment of the disc. Replacement of the malfunctioning device is associated with a high mortality, and therefore a more expeditious method is desirable. It is our experience that simple thrombectomy may suffice in most occasions, even for the mitral position, and especially when done through a bicameral approach in order to visualize both supravalvular and infravalvular regions. The philosophy and results with thrombectomy and disc rotation in 12 cases of thrombotic occlusion of the Björk-Shiley valve are described. It is suggested that this method may be preferable to replacement of the thrombosed prosthetic valve in select patients.