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Results with mechanical cardiac valvular prostheses

C W Akins1

  • 1Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.

The Annals of Thoracic Surgery
|December 1, 1995
PubMed
Summary

Mechanical heart valves are widely used, but none are perfect. The Medtronic-Hall and St. Jude Medical valves show better long-term results, with a new index favoring Medtronic-Hall, especially in the aortic position.

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Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Medical Device Evaluation

Background:

  • Mechanical cardiac valves are preferred over bioprostheses for heart valve replacement.
  • Five mechanical heart valve models are approved in the US: Starr-Edwards, Medtronic-Hall, St. Jude Medical, Omniscience, and CarboMedics.
  • No mechanical valve is without limitations, possessing unique advantages and disadvantages.

Purpose of the Study:

  • To review long-term outcomes of currently available mechanical heart valves.
  • To introduce a novel composite index for assessing thrombogenic potential and anticoagulation needs.
  • To evaluate the performance of mechanical valves using this new index.

Main Methods:

  • Review of published long-term results for Starr-Edwards, Medtronic-Hall, St. Jude Medical, Omniscience, and CarboMedics valves.
  • Development and application of a composite thromboembolism and bleeding index.
  • Comparative analysis of valve performance based on the new index.

Main Results:

  • Published data suggest better long-term outcomes for Medtronic-Hall and St. Jude Medical valves.
  • The composite index provides a new metric for evaluating valve thrombogenicity and anticoagulation requirements.
  • The Medtronic-Hall valve demonstrated a modest advantage, particularly in the aortic position, according to the new index.

Conclusions:

  • Mechanical heart valve selection requires careful consideration of individual patient factors and valve-specific attributes.
  • The composite thromboembolism and bleeding index offers a valuable tool for comparing mechanical heart valve safety and efficacy.
  • The Medtronic-Hall valve shows promise, especially for aortic valve replacement, based on this comprehensive assessment.

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