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Valvular heart disease: a perspective
Insights
Valve replacement significantly improves patient symptoms and hemodynamics. Long-term survival rates vary by prosthesis type, with mechanical valves requiring anticoagulant therapy and bioprostheses showing increasing failure after five years.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Valvular heart disease management has been revolutionized by valve replacement surgery.
- Long-term outcomes and complications associated with different prosthetic valves require ongoing evaluation.
Purpose of the Study:
- To review the survival rates and clinical outcomes associated with various prosthetic heart valves.
- To discuss the management implications, including anticoagulant and antibiotic prophylaxis, following valve replacement.
Main Methods:
- Review of historical and contemporary survival data for Starr-Edwards, Björk-Shiley, and porcine bioprosthetic valves.
- Analysis of symptomatic improvement and hemodynamic changes post-valve replacement.
- Discussion of long-term management strategies and complication prevention.
Main Results:
- 10 and 15-year survival rates for Starr-Edwards valves are 56% and 44%, respectively.
- Early survival (5-7 years) is similar across Starr-Edwards, Björk-Shiley, and porcine valves.
- Recent surgical cohorts demonstrate improved survival compared to earlier decades.
- Mechanical prostheses necessitate lifelong coumadin therapy; bioprostheses exhibit increasing failure rates after 5 years.
- Valve replacement generally leads to significant symptomatic improvement and enhanced ventricular function in select patients.
Conclusions:
- Prosthetic heart valve replacement offers substantial clinical benefits for patients with valvular heart disease.
- Long-term management requires careful consideration of prosthesis type, anticoagulation, and infection prophylaxis.
- Further research is needed to fully elucidate the role of vasodilators and long-term bioprosthetic valve durability.
Abstract:
Valve replacement has been one of the most important advances in the management of patients with valvular heart disease. The 10 and 15 year survival rate after isolated aortic and mitral valve replacement with the Starr-Edwards valve is 56 and 44%, respectively. At 5 and 7 years, survival with the Björk-Shiley, porcine bioprosthesis and the Starr-Edwards valve is similar. Patients operated on during the last 5 to 10 years have a much better survival rate than those operated on in the 1960s; therefore, the 10 and 15 year survival of those operated on recently should improve. All patients with a mechanical prosthesis need long-term anticoagulant therapy with drugs of the coumadin type. Porcine bioprostheses have a low failure rate up to 5 years after valve replacement; after this, valve failure occurs at an increasing rate, but the incidence at 10 and 15 years is not known. Valve replacement usually produces a marked improvement in the symptomatic status of the patient because of improved hemodynamics; ventricular function is improved in selected subsets of patients. The role of long-term vasodilator therapy has not been fully determined. Antibiotic prophylaxis for secondary prevention of rheumatic carditis and for prevention of infective endocarditis is important.