Prosthetic and Homograft Heart Valves

  • Ozuru O. Ukoha
  • John A. Elefteriades


Tuffier performed an aortic valvulotomy in 1912, and Cutler, a mitral commissurotomy in 1923, but it wasn’t until 1953, when cardiopulmonary bypass was developed, that surgeons, by direct visualization of valvular pathology, began in earnest to explore the range of possibilities in the treatment of these abnormalities. Prosthetic valves were placed initially in the descending aorta, but in 1960 Harken et al. achieved much better outcomes by placing them proximally into the aortic annulus.1 During the same year, Starr replaced the mitral valve with a mechanical ball-and-cage valve.2 Since then, prosthetic valve surgery has enjoyed ever-increasing success. Following mitral valve replacement, pulmonary hypertension is relieved3–6 and following aortic valve replacement, the compensatory mechanisms of hypertrophy and/or ventricular dilatation regress7,8 and impaired ventricular performance improves.8,9 Thousands of patients undergo valve replacement annually worldwide.


Aortic Valve Replacement Prosthetic Valve Mitral Valve Replacement Mechanical Valve Bioprosthetic Valve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Harken DE, Soroff HS, Taylor Wf, et al. Partial and complete prosthesis in aortic insufficiency. J Thorac Cardiovasc Surg. 1960;44:744–762.Google Scholar
  2. 2.
    Starr A, Edwards ML. Mitral replacement: a clinical experience with the ball valve prosthesis. Ann Surg. 1961;154:726–740.PubMedCrossRefGoogle Scholar
  3. 3.
    Ellis FH, Kirklin JW, Parker RK, et al. Mitral commissurotomy: an overall appraisal of clinical and hemodynamic results. Arch Intern Med. 1954;94:774–784.CrossRefGoogle Scholar
  4. 4.
    Selzer A, Malmborg RO. Some factors influencing changes in pulmonary vascular resistance in mitral valvular disease. Am J Med. 1962;32:532–544.CrossRefGoogle Scholar
  5. 5.
    Braunwald E, Braunwald NS, Ross J Jr., Morrow AG. Effects of mitral valve replacement on the pulmonary vascular dynamics of patients with pulmonary hypertension. N Engl J Med. 1965;273:509–514.PubMedCrossRefGoogle Scholar
  6. 6.
    Dalen JE, Matloff JM, Evans GL, et al. Early reduction of pulmonary vascular resistance after mitral valve replacement. N Engl J Med. 1967;277:387–394.PubMedCrossRefGoogle Scholar
  7. 7.
    Kennedy JW, Doces J, Stewart DK. Left ventricular function before and following aortic valve replacement. Circulation. 1977;56:944–950.PubMedCrossRefGoogle Scholar
  8. 8.
    Pantley G, Morton MJ, Rahimtoola SH: Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and aortic incompetence. J Thorac Cardiovac Surg. 1978;75:383–391.Google Scholar
  9. 9.
    Smith N, McAnulty J, Rahimtoola SH. Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. Circulation. 1978;58:255–264.PubMedCrossRefGoogle Scholar
  10. 10.
    Bojar RM. Valvular heart disease, including hypertrophic cardiomyopathy. In: Bojar RM. Adult Cardiac Surgery. Cambridge, Mass: Blackwell Scientific Publications; 1992:154–240.Google Scholar
  11. 11.
    Akins CW. Mechanical cardiac valvular prosthesis. Ann Thorac Surg. 1991;52:161–172.PubMedCrossRefGoogle Scholar
  12. 12.
    Akins CW. Results with mechanical cardiac valvular prosthesis. Ann Thorac Surg. 1995;60:1836–1844.PubMedCrossRefGoogle Scholar
  13. 13.
    Copeland JG. The Carbomedics prosthetic heart valve: a second generation bileaflet prosthesis. Sem Thorac Cardiovasc Surg. 1996;8:237–241.Google Scholar
  14. 14.
    Akins CW. Medtronic-Hall prosthetic aortic valve. Sem Tharac Cardiovasc Surg. 1996;3:242–248.Google Scholar
  15. 15.
    Edmunds LH Jr., Clark RE, Cohn LH, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg. 1988;46:257–259.CrossRefGoogle Scholar
  16. 16.
    Feldman HJ, Gray RJ, Chaux A, et al. Noninvasive in-vivo and in-vitro study of the St Jude Medical mitral valve prosthesis. Am J Cardiol. 1982;49:1101–1109.CrossRefGoogle Scholar
  17. 17.
    Panidis IP, Ren JF, Kotler MN, et al. Clinical and echocardiographic evaluation of the St Jude cardiac valve prosthesis following 126 patients. J Am Coll Cardiol. 1984;4:454–462.PubMedCrossRefGoogle Scholar
  18. 18.
    Kazui T, Komatsu S, Inoue N. Clinical evaluation of the Omniscience aortic disc valve prosthesis. Scand J Thorac Cardiovac Surg. 1987;21:173–174.CrossRefGoogle Scholar
  19. 19.
    Carrier M, Martineau JP, Bonan R, Polletier LC. Clinical and hemodynamic assessment of the Omniscience prosthetic heart valve. J Thorac Cardiovasc Surg. 1987;93:300–307.PubMedGoogle Scholar
  20. 20.
    Chesebro JH, Fuster V, Elveback LR, et al. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin combined with dipyridamole. Am J Cardiol. 1983;51:1537–1541.PubMedCrossRefGoogle Scholar
  21. 21.
    Butchart EG, Lewis PA, Bethel JA, Breckenridge JM. Adjusting anticoagulation to prosthesis: thrombogenicity and patient risk factors. Recommendations for the Medtronic-Hall valve. Circulation. 1991;84(suppl III): III61–III69.PubMedGoogle Scholar
  22. 22.
    Stein PD, Alpert JS, Copeland J, et al. Antithrombotic therapy in patients with mechanical and biologic prosthetic heart valves. Chest. 1992;102:445S–455S.PubMedCrossRefGoogle Scholar
  23. 23.
    Eckman MH, Beshansky JR, Durand-Zaleski I, et al. Anticoagulation for noncardiac procedures in patients with prosthetic heart valves. Does low risk mean high cost? JAMA. 1990;263:1513–1521.PubMedCrossRefGoogle Scholar
  24. 24.
    Rahimtoola SH. Valvular heart disease: a perspective. J Am Coll Cardiol. 1983;1:199–215.PubMedCrossRefGoogle Scholar
  25. 25.
    Cowgill LD, Addonizio VP, Hopeman AR, Harken AH. A practical approach to prosthetic valve endocarditis. Ann Thorac Surg. 1987;43:450–457.PubMedCrossRefGoogle Scholar
  26. 26.
    Fann JI, Miller DC. Porcine valves: Hancock and Carpentier-Edwards aortic prostheses. Sem Thorac Cardiovasc Surg. 1996;8:259–268.Google Scholar
  27. 27.
    Rossiter SJ, Miller DC, Stinson EB, et al. Hemodynamic and clinical comparison of the Hancock Modified Orifice and standard orifice bioprosthesis in the aortic position. J Thorac Cardiovasc Surg. 1980;80:54–60.PubMedGoogle Scholar
  28. 28.
    Cohn LH, Couper GS, Aranki SF, et al. The long-term follow-up of the Hancock Modified Orifice porcine bioprosthetic valve. J Cardiac Surg. 1991;6:557–561.Google Scholar
  29. 29.
    Cohn LH, DiSesa VJ, Collins JJ Jr. The Hancock Modified Orifice porcine bioprosthetic valve; 1976–1988. Ann Thorac Surg. 1989;48:S81–S82.PubMedCrossRefGoogle Scholar
  30. 30.
    Fernandez J, Chen C, Gu J, et al. Comparison of low pressure versus standard pressure fixation Carpentier-Edwards bioprosthesis. Ann Thorac Surg. 1995;60:S205–S210.PubMedCrossRefGoogle Scholar
  31. 31.
    David TE, Armstrong S, Sun E. The Hancock II bioprosthesis at 10 years. Ann Thorac Surg. 1995;60:S229–S234.PubMedCrossRefGoogle Scholar
  32. 32.
    Sarris GE, Robbins RC, Miller DC, et al. Randomized prospective assessment of bioprosthetic valve durability: Hancock versus Carpentier-Edwards valves. Circulation. 1993;88(pt 2):55–64.Google Scholar
  33. 33.
    Bolooki H, Kaiser GA, Mallon SM, Palatianos GM: Comparison of long-term results of Carpentier-Edwards and Hancock bioprosthetic valves. Ann Thorac Surg. 1986;42:494–499.PubMedCrossRefGoogle Scholar
  34. 34.
    Jones EL, Weintraub WS, Graver JM, et al. Interaction of age and coronary disease after valve replacement: implications for valve selection. Ann Thorac Surg. 1994;58:378–385.PubMedCrossRefGoogle Scholar
  35. 35.
    Lytle BW, Cosgrove DM, Taylor PC, et al.: Primary isolated aortic valve replacement: early and late results. J Thorac Cardiovasc Surg. 1989;97:675–694.PubMedGoogle Scholar
  36. 36.
    Burdon TA, Miller DC, Oyer PE, et al. Durability of porcine valves at fifteen years in a representative North American population. J Thorac Cardiovasc Surg. 1992;103:238–252.PubMedGoogle Scholar
  37. 37.
    Akins CW, Carroll D, Buckley MJ, et al. Late results with Carpentier-Edwards porcine bioprosthesis. Circulation. 1990;82(suppl 4):65–74.Google Scholar
  38. 38.
    Milligan DJ Jr., Lewis JW, Stein P, Alam M: The porcine bioprosthetic heart valve: experience at 15 years. Ann Thorac Surg. 1989;48:324–330.CrossRefGoogle Scholar
  39. 39.
    Cohn LH, Collins JJ Jr., DiSesa V, et al. Fifteen-year experience with 1678 Hancock porcine bioprosthetic heart valve replacements. Ann Surg. 1989;210:435–443.PubMedCrossRefGoogle Scholar
  40. 40.
    Jones EL, Weintraub WS, Craver JM, et al. Ten-year experience with the porcine bioprosthetic valves: Interrelationship of valve survival and patient survival in 1050 valve replacements. Ann Thorac Surg. 1990;49:370–384.PubMedCrossRefGoogle Scholar
  41. 41.
    Milano AD, Bortolotti U, Mazzucco A, et al. Performance of the Hancock porcine bioprosthesis following aortic valve replacement: considerations based on a 15 year experience. Ann Thorac Surg. 1988;46:216–222.PubMedCrossRefGoogle Scholar
  42. 42.
    Jamieson WRE, Munro AI, Miyagishima RT, et al. Carpentier-Edwards standard porcine bioprosthesis: clinical performance to seventeen years. Ann Thorac Surg. 1995;60:999–1007.PubMedCrossRefGoogle Scholar
  43. 43.
    Glower DD, White WD, Hatton AC, et al. Determinants of reoperation after 960 valve replacements with Carpentier-Edwards prostheses. J Thorac Cardiovasc Surg. 1994;107:381–393.PubMedGoogle Scholar
  44. 44.
    Pelletier LC, Carrier M, Leclerc Y, et al. Influence of age on late results of valve replacement with porcine bioprostheses. J Thorac Cardiovasc Surg. 1992;33:526–533.Google Scholar
  45. 45.
    Grunkemeier GL, Jamieson WRE, Miller DC, Starr A: Actuarial versus actual risks of porcine structural valve deterioration. J Thorac Cardiovasc Surg. 1994;108:709–718.PubMedGoogle Scholar
  46. 46.
    Bernal JM, Rabasa JM, Lopez R, et al. Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position. Ann Thorac Surg. 1995;60:S248–S252.PubMedCrossRefGoogle Scholar
  47. 47.
    Papello DF, Bessone LN, Hiro SP, et al. Bioprosthetic valve longevity in the elderly: an 18-year longitudinal study. Ann Thorac Surg. 1995;60:S270–S275.CrossRefGoogle Scholar
  48. 48.
    Carpentier A, Dubost C, Lane E. Continuing improvement in valvular prostheses. J Thorac Cardiovasc Surg. 1982;83:27–42.PubMedGoogle Scholar
  49. 49.
    David TE, Ropchan GC, Butany JW. Aortic valve replacement with stentless porcine bioprostheses. J Cardiac Surg. 1988;3:501–505.CrossRefGoogle Scholar
  50. 50.
    David TE, Pollick C, Bos J. Aortic valve replacement with stentless porcine aortic bioprostheses. J Thorac Cardiovasc Surg. 1990;99:113–118.PubMedGoogle Scholar
  51. 51.
    Binet JP, Duran CG, Carpentier A, Langlois J. Heterologous aortic valve transplantation Lancet. 1965;2:1275.PubMedCrossRefGoogle Scholar
  52. 52.
    O’Brein MF, Clarebrough JK. Heterograft aortic valve transplantation for human valve disease. Med J Aust. 1966;2:228–230.Google Scholar
  53. 53.
    Jin XY, Gibson DG, Yacoub MH, Pepper JR: Perioperative assessment of aortic homograft, Toronto stentless valve and stented valve in the aortic position. Ann Thorac Surg. 1995;60:S395–S401.PubMedCrossRefGoogle Scholar
  54. 54.
    Casabona R, DePaulis R, Zattera GF, et al. Stentless porcine and pericardial valve in aortic position. Ann Thorac Surg. 1992;54:681–685.PubMedCrossRefGoogle Scholar
  55. 55.
    Cohn LH, Koster JK, Mee RBB, Collins JJ Jr. Long-term follow-up of the Hancock bioprosthetic heart valve: a 6-year review. Circulation. 1979;60(suppl):187–192.Google Scholar
  56. 56.
    Davila JC, Magilligan DJ Jr., Lewis JW Jr. Is the Hancock porcine valve the best cardiac valve substitute today? Ann Thorac Surg. 1978;26:303–316.PubMedCrossRefGoogle Scholar
  57. 57.
    Craver JM, King SB III, Douglas JS, et al. Late hemodynamic evaluation of Hancock modified orifice aortic bioprosthesis. Circulation. 1979;60(suppl):193–197.Google Scholar
  58. 58.
    Hannah H III, Reis RL. Current status of porcine heterograft prosthesis: a 5-year appraisal. Circulation. 1976;54(suppl):27–31.Google Scholar
  59. 59.
    Johnson A, Thompson S, Vieweg WVR, et al. Evaluation of the in-vivo function of the Hancock porcine xenograft valve. J Thorac Cardiovasc Surg. 1978;76:599–605.Google Scholar
  60. 60.
    Morris DC, King SB III, Douglas JJ Jr., et al. Hemodynamic results of aortic valvular replacement with the porcine xenograft valve. Circulation. 1977;56:841–844.PubMedCrossRefGoogle Scholar
  61. 61.
    Jones EL, Craver JM, Morris DC, et al. Hemodynamic and clinical evaluation of the Hancock xenograft bioprosthesis for aortic valve replacement (with emphasis on management of the small aortic root). J Thorac Cardiovasc Surg. 1978;76:300–308.Google Scholar
  62. 62.
    Ionescu MI, Tandon AP, Mary DAS, Abid A. Heart valve replacement with the Ionescu-Shiley pericardial xenograft. J Thorac Cardiovasc Surg. 1977;73:31–42.PubMedGoogle Scholar
  63. 63.
    Becker RM, Strom J, Fishman W, et al. Hemodynamic performance of the Ionescu-Shiley valve prosthesis. J Thorac Cardiovasc Surg. 1980;80:613–620.PubMedGoogle Scholar
  64. 64.
    Willey VM, Keon WJ. Patterns of failure in Ionescu-Shiley bovine pericardial bioprosthetic valves. J Thorac Cardiovasc Surg. 1987;93:925–933.Google Scholar
  65. 65.
    Gonzalez-Levin L, Chi S, Blair C, et al. Five-year experience with the Ionescu-Shiley bovine pericardial valve in the aortic position. Ann Thorac Surg. 1983;36:270–280.CrossRefGoogle Scholar
  66. 66.
    Frater RWM, Salomon NW, Rainer WG, et al. The Carpentier-Edwards pericardial aortic valve: intermediate results. Ann Thorac Surg. 1987;94:200–207.Google Scholar
  67. 67.
    Cosgrove DM. Carpentier pericardial valve. Sem Thorac Cardiovasc Surg. 1996;8:269–275.Google Scholar
  68. 68.
    Pelletier LC, Leclerc Y, Bonan R, et al. Aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: clinical and hemodynamic results. J Cardiac Surg. 1988;3:405–412.Google Scholar
  69. 69.
    Gabbay S, Frater RWM. In-vitro comparison of the newer heart valve bioprosthesis in the mitral and aortic positions. In: Cohn LH, Galluccci V, eds. Cardiac Prostheses. Proceedings of the Second International Symposium. Stoneham, Mass: York Medical Books; 1982:456–468.Google Scholar
  70. 70.
    Cosgrove DM, Lytle BW, Taylor PC. The Carpentier-Edwards pericardial aortic valve: 10-year results. J Thorac Cardiovasc Surg. 1995;110:651–662.PubMedCrossRefGoogle Scholar
  71. 71.
    Perier P, Mihacleanu S, Fabiani JN, et al. Long-term evaluation of the Carpentier-Edwards pericardial valve in the aortic position. J Card Surg. 1991;6(suppl):589–594.PubMedGoogle Scholar
  72. 72.
    Burdon TA, Miller DC, Oyer PE, et al. Durability of porcine valves at 15 years in a representative North American population. J Thorac Cardiovasc Surg. 1992;103:238–252.PubMedGoogle Scholar
  73. 73.
    Doty DB. Aortic valve replacement with homograft and autograft. Sem Thorac Cardiovasc Surg. 1996;8:249–258.Google Scholar
  74. 74.
    Ross DN. Replacement of aortic and mitral valves with pulmonary autograft. Lancet. 1967;2:956–958.PubMedCrossRefGoogle Scholar
  75. 75.
    Ross D, Jackson M, Davies J. Pulmonary autograft aortic valve replacement: long-term results. J Card Surg. 1991;6:529–533.PubMedCrossRefGoogle Scholar
  76. 76.
    Gorczynski A, Trenkner M, Anisimowicz L, et al. Biomechanics of the pulmonary autograft valve in the aortic position. Thorax. 1982;37:535–539.PubMedCrossRefGoogle Scholar
  77. 77.
    Elkins RC, Knott-Craig CJ, Ward KE, et al. Pulmonary autograft in children: realized growth potential. Ann Thorac Surg. 1994;57:1387–1394.PubMedCrossRefGoogle Scholar
  78. 78.
    Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978;58:20–24.PubMedCrossRefGoogle Scholar
  79. 79.
    Kouchoukos NT, Davila-Roman VG, Spray TL, et al. Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic valve disease. N Engl J Med. 1994;330:1–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Hiratzka LF, Kouchoukos NT, Grunkemeier GL, et al. Outlet strut fracture of the Bjork-Shiley 60° convexoconcave valve: current information and recommendation for patient care. J Am Coll Cardiol. 1988;11:1130–1137.PubMedCrossRefGoogle Scholar
  81. 81.
    Magilligan DJ Jr., Lewis JW Jr., Tilley B, Peterson E. The porcine bioprosthetic valve. Twelve years later. J Thorac Cardiovasc Surg. 1985;89:499–507.PubMedGoogle Scholar
  82. 82.
    Jamieson WRE, Rosado LJ, Munro, et al. Carpentier-Edwards standard porcine bioprosthesis: primary tissue failure (structural valve deterioration) by age groups. Ann Thorac Surg. 1988;46:155–162.PubMedCrossRefGoogle Scholar
  83. 83.
    Antunes MJ, Santos LP. Performance of glutaraldehyde-preserved porcine bioprosthesis as a mitral valve substitute in a young population group. Ann Thorac Surg. 1984;37:387–392.PubMedCrossRefGoogle Scholar
  84. 84.
    Jamieson WRE, Burr LH, Munro AI, et al. Cardiac valve performance in the elderly: clinical performance of biologic prostheses. Ann Thorac Surg. 1989;48:173–185.PubMedCrossRefGoogle Scholar
  85. 85.
    O’Brien MF, Stafford EG, Gardner MAH, et al. A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies. J Thorac Cardiovasc Surg. 1987;94:812–823.PubMedGoogle Scholar
  86. 86.
    Matsuki O, Okita Y, Almeida RS, et al. Two decades’ experience with aortic valve replacement with pulmonary autograft. J Thorac Cardiovasc Surg. 1988;95:705–711.PubMedGoogle Scholar
  87. 87.
    Mitchell RS, Miller DC, S’tinson EB, et al. Significant patient-related determinants of prosthetic valve performance. J Thorac Cardiovasc Surg. 1986;91:807–817.PubMedGoogle Scholar
  88. 88.
    Hammermeister KE, Henderson WG, Burchfield CM, et al. Comparison of outcome after valve replacement with a bioprosthesis versus a mechanical prosthesis: initial 5-year results of a randomized trial. J Am Coll Cardiol. 1987;10:719–732.PubMedCrossRefGoogle Scholar
  89. 89.
    Hammond GL, Geha AS, Kopf GS, Hahim SW. Biologic versus mechanical valves. Analysis of 1116 valves inserted in 1012 adult patients with a 4818 patient-year and a 5327 valve-year follow-up. J Thorac Cardiovasc Surg. 1987;93:182–198.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Ozuru O. Ukoha
  • John A. Elefteriades

There are no affiliations available

Personalised recommendations