Durability of bioprosthetic cardiac valves

Abstract

Introduction: The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement.

Methods: Selective literature search in Medline/PubMed back to 1996 and review of current national and international recommendations from specialist societies.

Results: The recommendations guiding the type of heart valve replacement have been revised in recent years. Of particular interest are the new generation of biological prostheses with extended durability, a growing use of stentless bioprostheses, a decrease in mortality of reoperation and an increase in life expectancy. Comorbidities such as chronic renal insufficiency or chronic atrial fibrillation are no longer contraindications to bioprosthesis. The number of heart valve replacements in recent years rose despite a concomitant increase in valve repairs. Aortic valves are being increasingly replaced by bioprostheses.

Discussion: The choice of heart valve prosthesis should be tailored to each patient taking into account the patient's age, life expectancy, comorbidities, and life style. Different decisions may be made now than those based on earlier recommendations resulting in an individualized treatment, in patients over the age of 65 or 70.

Keywords: biomaterial; cardiac surgery; cardiac valve replacement; comorbidity; guideline; indication.

Figure 1

A selection of stented valvular prostheses: a) Hancock IITM, b) Carpentier-Edwards, c) Mosaic, d) Perimonnt. From: Edmunds L, Cohn L: Cardiac surgery in the adult, 2003, with kind permission from McGraw-Hill, New York

Figure 2

A selection of stentless valvular bioprostheses: a) Freedom Solo, Sorin Group; b) Prima Plus, Edwards; c) NR200, Shelhigh. With kind permission from the Sorin Group, Edwards, and Shelhigh companies.