Mechanical or Tissue Valves: Factors Influencing Differential Therapy

  • D. Horstkotte
  • H. D. Schulte
  • W. Bircks

Abstract

The late outcome of heart valve replacement can be determined by subjective improvement, improvement of functional capacity and central hemodynamics, normalization of impaired ventricular function by the frequency of complications related to or induced by the prosthesis, and by postoperative survival. According to these advantages and disadvantages of bioprostheses and mechanical valves, a differential therapy and an individualized approach should be preferred. Considering the durability of bioprostheses currently available, mechanical valves are favorable inpatients younger than 35-years-old and particularly in children, in whom rapid calcification must be expected. Regarding valve implantation in older patients, recent improvement in life expectancy has to be considered, indicating a high probability of reoperation even in patients with bioprosthetic valve replacement at the age of 65 years. Weighing the risks and benefits, anticoagulation has to be recommended in a substantial number of patients with mitral bioprostheses, which means that these patients would not receive enough benefit from bioprosthetic valve implantation. In atrioventricular valve replacement and in aortic valve implants, in which only small-sized prostheses can be used, the hemodynamic disadvantage of bioprostheses may limit the overall operative success. In these patients, for hemodynamic reasons, a modern mechanical valve should be preferred. Moreover, an expected high risk of reoperation would discourage tissue valve implantation.

Keywords

Anemia Peri Cardiol Perforation Stein 

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© Kluwer Academic Publishers 1989

Authors and Affiliations

  • D. Horstkotte
  • H. D. Schulte
  • W. Bircks

There are no affiliations available

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