Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results

Choice of A Valve Prosthesis

Author(s): Wilhelm Peter Mistiaen

Pp: 142-168 (27)

DOI: 10.2174/9781608052875113010009

* (Excluding Mailing and Handling)

Abstract

Aortic valve replacement has been applied for over half a century. Two classes of devices have been developed: mechanical and biological valve prostheses. For biological devices, autografts, homografts and xenografts (porcine and pericardial) have been developed. For mechanical devices, cage ball, tilted disc and bi-leaflet valves have been designed.

For BHV, the main drawback is a limited durability, the main advantage is the low rate for TE events, which obviates the need for peroral anticoagulation. Age is a major determinant for durability. In contrast, MHV are very durable, but they require a lifelong anticoagulation with all their side effects. The choice for a valve in each individual patients depends on several factors: age and life expectancy are the main factors.

In difficult situations, i.e. an age between 55 and 70 years, results of comparative studies might be helpful in the decision making. Comparison should include contemporary devices and techniques. Use of historical series are confounded by changes and improvements in peri and postoperative care. A RCT remains the gold standard, but these are few in numbers.

The only recent RCT did not change much: the outcome is still more dependent on patient related factors than on the type of the valve, except 1) for bleeding, which is more common with MHV and 2) for SVD, which is observed with BHV. These observations are hardly surprising.

Results for a twenty-year follow-up might be needed. The preference of physician and patients for the choice of a valve is important. The dilemma between anticoagulation related bleeding and SVD remains for the time being.


Keywords: Anticoagulation, autografts, biological heart valve prosthesis, bleeding, calcification, effective orifice area, homografts, mechanical heart valve prosthesis, mortality, stentless xenografts, structural valve degeneration, thrombembolism, transvalvular gradient, tissue engineered heart valves, valve prosthesis patient mismatch.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316674267 and j.to_ip >=316674267 )) and ((j.from_date <= 1739848405 and j.to_date >= 1739848405 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4699) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316674267 and j.to_ip >=316674267 )) and ((j.from_date <= 1739848405 and j.to_date >= 1739848405 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4699) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316674267 and j.to_ip >=316674267 )) and ((j.from_date <= 1739848405 and j.to_date >= 1739848405 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4699)
      650μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1141 and `b`.`banner_from_date` <= 1739848405 and `b`.`banner_to_date` >= 1739848405 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.1msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1141
      • 3: 1739848405
      • 4: 1739848405
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='ae7bf8735366ff04d46847c1214a4176'
      250μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    15Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        qtFsnOmG7NvnD0DQdF98SioL7u0NT1hGJFb5RR6u
        uc_cart_id
        ae7bf8735366ff04d46847c1214a4176
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4699" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4699
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        session_attributes
        0 of 0
        array:5 [ "_token" => "qtFsnOmG7NvnD0DQdF98SioL7u0NT1hGJFb5RR6u" "uc_cart_id" => "ae7bf8735366ff04d46847c1214a4176" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4699" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:13:25GET/chapter/46991121917