PRESENT STATUS AND FUTURE OF THE PROSTHETIC HEART VALVE

Abstract

Durability and anti-thrombogenicity of the prosthetic heart valve and results of prosthetic valve re-replacement were discussed. In the isolated aortic valve replacement, the incidence of thromboembolism was significantly higher in the mechanical valve group (2.5±0.2%/P-Y vs. 0.5±0.3%/P-Y) (p<0.01). Structural valve failure was significantly more common in the bioprostheses group (0.2±0.2%/P-Y vs. 1.2±0.5%/P-Y) (p<0.05). The freedom from medical treatment in the late postoperative state was significantly higher in the bioprosthetic valve group (2.9% vs. 37.7%)(p<0.0001). In the isolated mitral valve replacement, the incidence of thromboembolism and anticoagulant-related hemorrhage was higher in the mechanical valve group (4.1±0.9%/P-Y vs. 2.2±0.4%/P-Y). Structural valve failure was significantly more comnnon in the bioprostheses group (0.4±0.3%/P-Y vs. 2.0±0.4%/P-Y) (p<0.01). In the isolated tricuspid or pulmonary valve replacement, valve failure was more common in the mechanical valve group (7.3±3.6%/P-Y vs. 0.5±0.5%/P-Y)(p<0.01). The valve-related events were more common in the mechanical valve group (9.1±4.1%/P-Y vs. 1.9±1.0%/P-Y)(p<0.001). In the prosthetic valve r-ereplacement, there was significant difference in the actuarial survival curve between single and double valve replacement group (p<0.001). In the single valve re-replacement for primary tissue failure of bioprostheses, actuarial survival rate at 5 years was 96±4%. We conclude that the benefit of bioprostheses (antithrombogenicity) is put to practical use in the case of aortic valve or right-side heart valve replacement.