Standards and Concepts in Valve Surgery

1Introduction

With the advent of open heart surgery, it has been possible to actively fight valvular diseases. Before World War II, there were some reports of operations on the heart, but these operations were rare and anecdotal. Closed techniques were performed occasionally in mitral surgery after World War II. After 1952, a major breakthrough occurred with the introduction of artificial valves and coronary artery bypass graft (CABG) surgery for open heart surgery.

Standards are technical specifications that ensure all procedures are understood and widely accepted. Concepts are abstract ideas or new developments that may become standards if widely accepted. The first artificial valves were designed in the 1950s as ball valves, and later as monoleaflet and bileaflet valves in aortic and mitral positions. Biological valves were developed in the 1960s. Open-valve reconstruction and other techniques were introduced in the late 60s. These techniques were used first for mitral stenosis and later for mitral regurgitation and homografts.

The standard for valve replacement is to use extracorporeal circulation (ECC) with myocardial protection. In most cases, reconstruction of the diseased valve will not result in good long-term results. Therefore, replacement with an artificial valve is preferred. Concomitant bypass surgery as indicated is performed. Device selection remains a challenge and must be tailored to the patient in conjunction with valve surgery. There are concepts in reconstructing the aortic valve as well as in designing new valves.

The management, including diagnostic and postoperative treatment, of patients with valvular diseases is complex. Valve selection can play an important role in the long-term outcome.

The following standards are set for surgeons:

Indication and Postoperative management.

A previous task force of the American College of Cardiology and the American Heart Association [1] gave an excellent basis for classifying and fostering a useful terminology for cardiac surgeons and cardiologists. Demographics, life span, and epidemiologic characteristics of disease have changed globally in the last 30 years. The availability of cardiac surgery worldwide is highly variable and discrepant, with the USA and Europe offering more accessibility to open heart surgery facilities [2].

References

• 1 Bonow R O, Carabello B. et al . Guidelines for the Management of Patients with Valuvlar Heart Disease. ACC/AHA Task Force on Practice Guidelines.  Circulation.. 1998;  98 1949-84
• 2 Unger F. Worldwide Survey on Cardiac Interventions 1995.  Cor Europaeum.. 1999;  7 128-46
• 3 Jamieson W RE, Edwards F H. et al . Risk Stratification for Cardiac Valve Replacement: STS National Cardiac Surgery Database.  Ann Thorac Surg.. 1999;  67 943-51

Annex

Tables

Valve	Type	Introduced
1. Mechanical valves
Gott	leaflet	1963
Hufnagel	ball	1963
Magovern-Cromie	ball	1963
Kay-Susuki	disc	1964
Starr Edwards 1000	ball	1964
Starr Edwards 6000	ball	1964
Kay-Shiley	disc	1965
Smeloff Culter	ball	1966
Starr Edwards 1200	ball	1966
Starr Edwards 6120	ball	1966
Cross-Jones	disc	1967
Harken P2	disc	1967
Starr Edwards 2300	ball	1967
Starr Edwards 6300	ball	1967
Wada	disc	1967
Braunwald-Cutter	ball	1968
Braunwald-Cutter/M/T	ball	1968
Starr Edwards 2310	ball	1968
Starr Edwards 6310	ball	1968
Starr Edwards 6500	disc	1968
Björk-Shiley TSD	disc	1969
DeBakey-Surgitool	ball	1969
Starr Edwards 2320	ball	1970
Starr Edwards 6520	disc	1970
Cooley-Cutter/M/T	disc	1971
Starr Edwards 2400	ball	1972
Cooley-Cutter	disc	1973
Beall	disc	1974
Björk-Shiley	disc	1975
Lillehei-Kaster 500/300	disc	1975
Medtronic-Hall 7700/A,M	disc	1977
St. Jude Medical	bileaflet	1977
Omniscience	disc	1978
Björk-Shiley MS	disc	1981
Duromedics	bileafet	1982
Valve	Type	Introduced
2. Biological valves
Shumway Angell	fresh tissue	1969
Hancock	porcine	1969
Zerbini	dura mater	1971
Carpentier	porcine	1975
Angell-Shiley	porcine	1976
Ionescu-Shiley	pericardium	1976
Mitroflow	pericardium	1982
3. Valves in current use
I. Mechanical valves
Medtronic	- Medtronic Hall
St. Jude Medical	- Standard, HP, Regent, Masters
Sulzer	- Carbomedics, Top Hat, Sumit
Medical Carbon Research Inc.	- On-X
ATS Medical Inc.	- ATS
Sorin	- Monocast, Carbocast, Bicarbon
Baxter	- Starr-Edwards, Tekna, Mira
Medical Inc.	- Omniscience, Omnicarbon
Ultracor
Macchi
Chitra
St. Vincents
GuangDeong
II. Biological Valves
St Jude Medical	- Toronto SPV, Epic, Biocor
Medtronic	- Freestyle, Mosaic, Intact, Hancock II
Baxter	- Perimount, Carpentier-Edwards
Cryolife	- O'Brien, Ross
Sulzer	- Synergy, Mitroflow, Labcor