Related Experiment Videos
[Directions for reoperation of patients with Björk-Shiley convexo-concave valve prosthesis, based on long-term
Insights
The Björk-Shiley convexo-concave (C-C) valve shows long-term results comparable to the St. Jude Medical (SJM) valve. However, elective replacement is debated due to the high risk of life-threatening strut fractures.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Valve Research
Context:
- The Björk-Shiley convexo-concave (C-C) valve prosthesis is associated with a high incidence of strut fracture.
- Elective replacement of functioning C-C valves remains controversial.
Purpose:
- To evaluate the long-term outcomes of C-C valve prostheses.
- To compare the performance of C-C valves with St. Jude Medical (SJM) valves.
- To inform clinical policy regarding C-C valve management.
Summary:
- A review of 28 patients with C-C valves showed low rates of structural deterioration (0.30%/patient-year) and thromboembolism (1.20%/patient-year).
- Long-term actuarial analysis at 10 years indicated comparable survival and event-free rates between C-C and SJM valves.
- Reoperation-free rates were significantly lower for C-C valves (91.6%) compared to SJM valves (98.0%, p < 0.05).
Impact:
- The study suggests C-C valve long-term results are compatible with SJM valves, but strut fracture poses a significant, life-threatening risk.
- The hospital mortality for re-replacement (2.6%) approaches the cumulative risk of strut fracture (3.0%) at 10 years, highlighting the critical nature of this complication.
Abstract:
Although a high incidence of strut fracture of the Björk-Shiley convexo-concave (C-C) valve prosthesis has been reported, it is still controversial whether the prosthesis functioning normally should be replaced electively. To clarify our policy for this issue, we reviewed 28 patients who had undergone mitral valve replacement with a C-C valve prosthesis, and evaluated long-term results according to STS guidelines. The incidence of valve-related complications expressed as % patient-year were; structural deterioration 0.30, nonstructural dysfunction 0.30, thromboembolism 1.20. There were no thrombosed valves, anticoagulant-related hemorrhage or prosthetic valve endocarditis. The actuarial free rate after valve replacement with the C-C at 10 years, constructed by the Kaplan-Meier method, were compared with those with St. Jude Medical (SJM) valve prosthesis. (1) Actuarial survival: 77.9 vs 87.3 (NS), (2) Reoperation-free: 91.6 vs 98.0 (p < 0.05), (3) thromboembolism-free: 83.7 vs 83.9 (NS), (4) Event-free (hospital death+reoperation+valve-related complications: 71.2 vs 77.7 (NS). The long-term results with the C-C were compatible to those with a SJM valve prosthesis. However, if a strut fracture occurs, it is very difficult to save the patient's life. The hospital mortality of re-replacement of valve prosthesis during the last 10 years, at our institute, was 2.6%, which is almost equal to the cumulative risk of strut fracture of the C-C valve after 10 years (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)