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Year of operation as a risk factor in the late results of valve replacement
Insights
Cardiac valve replacement with silicone ball valves shows significantly lower thromboembolic rates in the second decade compared to the first. This improvement highlights the importance of implantation timing in evaluating cardiac valve outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Technology
Background:
- Silicone ball valves have been used in cardiac valve replacement for decades.
- Previous studies indicated varying thromboembolic rates based on implantation era.
- Understanding temporal trends in prosthetic valve performance is crucial.
Purpose of the Study:
- To compare the thromboembolic rates of silicone ball valves implanted during the first and second decades of use.
- To assess the embolus-free rates of various prosthetic valves in mitral and aortic positions.
- To evaluate the current thromboembolic risk associated with standard silicone ball valves.
Main Methods:
- Actuarial analysis of thromboembolic rates for aortic and mitral silicone ball valves.
- Statistical comparison of embolus-free rates between implantation decades (p < 0.01).
- Calculation of five-year embolus-free rates for caged-ball, tilting disc, and porcine xenograft valves.
Main Results:
- Thromboembolic rates for silicone ball valves were significantly lower in the second decade of use compared to the first.
- Five-year embolus-free rates ranged from 81% to 92% (mitral) and 91% to 97% (aortic) for various valve types.
- Current silicone ball valves exhibit thromboembolic risks comparable to other contemporary valve substitutes.
Conclusions:
- The time frame of cardiac valve replacement significantly impacts thromboembolic event rates.
- Modern silicone ball valves demonstrate a reduced thrombogenicity, offering comparable safety to other prostheses.
- Evaluation of prosthetic cardiac valve results must account for the era of implantation.
Abstract:
The actuarial thromboembolic rates of aortic and mitral silicone ball valves used during the second decade of cardiac valve replacement are significantly lower than the rates for the same prostheses implanted during the first decade, as shown in the following table: (Formula: see text). The embolus-free rates are significantly different (p < 0.01) in both the mitral and aortic series. Five-year embolus-free rates for the composite-strut caged-ball, Björk-Shiley tilting disc, and porcine xenograft valves all fall in the range of from 81% to 92% for the mitral position and from 91% to 97% for the aortic. Thus the standard silicone ball-valve prosthesis, used during the current era, has a thromboembolic risk as low as that reported with other concurrently utilized valve substitutes. This striking reduction in thrombogenicity demonstrates that the time frame of implantation must be considered when evaluating the results of cardiac valve replacement.