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Cardiac valve replacement. Problems solved and unsolved.

H G Borst, N Papagiannakis, C Bedderman

    The Thoracic and Cardiovascular Surgeon
    |April 1, 1979
    PubMed
    Summary
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    This review examines cardiac valve replacement prostheses, focusing on durability, hemodynamics, and thromboembolic risk. Bioprosthetic valves are favored for reduced complications, especially in mitral valve replacement.

    Area of Science:

    • Cardiovascular Surgery
    • Biomedical Engineering
    • Prosthetic Devices

    Background:

    • Cardiac valve replacement is a critical procedure for treating valvular heart disease.
    • Various prosthetic valve models exist, each with distinct advantages and disadvantages.
    • Evaluating long-term outcomes is essential for optimizing patient care.

    Purpose of the Study:

    • To review the current state of cardiac valve replacement prostheses.
    • To compare mechanical and biological valves based on durability, hemodynamics, and thromboembolic risk.
    • To guide the selection of prosthetic valves in clinical practice.

    Main Methods:

    • Comprehensive literature review of cardiac valve replacement.
    • Analysis of personal experience with approximately 1500 prosthetic valve cases.

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  • Evaluation of valve durability, hemodynamic performance (rest and exercise), and thromboembolic risk.

    • Main Results:

    • Advanced mechanical valves show improved long-term durability; biological prostheses' durability remains an open question.
    • Hemodynamic performance is suboptimal in conventional mechanical prostheses and xenografts, with abnormal pressure gradients.
    • Bioprostheses demonstrate a significantly lower incidence of thromboembolism and valve thrombosis, with no anticoagulation-related accidents.

    Conclusions:

    • Bioprosthetic valves are currently favored due to lower thromboembolic risk and absence of anticoagulation complications.
    • Bioprostheses are particularly advantageous for mitral valve replacement and patients unsuitable for anticoagulation.
    • Further research is needed to address the long-term durability of biological prostheses and optimize hemodynamic performance of all valve types.