The Angell-Shiley porcine xenograft

A 4-year clinical experience with fresh allograft tissue valves prompted a trial of 0.5% buffered glutaraldehyde as a valve fixative and sterilant. Tanned allograft and porcine xenograft valves were inserted into experimental animals, and, beginning in 1970, similar valves were implanted in a series of patients now totaling 312. The clinical results are excellent. The 5-year valve-related mortality is 6% for patients who had mitral valve replacement and 16% for those with aortic valve replacement. To date, the incidence of thromboembolism is 1.3% per patient-year, and valve-related morbidity and mortality for the combined groups is 27.4%. Valve stent design has evolved from symmetrically configured metal to anatomically molded plastic. The maintenance of natural valve configuration has optimized leaflet coaptation and support, decreased tissue stress, and eliminated valve-stent dehiscence and tissue rupture seen in valves deformed to fit symmetrical stents. Stent design, controlled glutaraldehyde solutions, and fixation techniques have improved leaflet flexibility and reduced valve orifice to annulus diameter ratios, thus producing transvalvular gradients comparable to both mechanical and modified orifice tissue valves. To date, tissue failure, observed in only 1.0% (3 of 287) of patients, is the result of calcification (2 patients) and cusp rupture due to incomplete fixation (1 patient).