Nine Years' Experience with the Björk-Shiley Prosthetic Valve: Early and Late Results of 932 Valve Replacements

Daenen, Willem; Nevelsteen, André; Cauwelaert, P. Van; Maesschalk, E de; Willems, Jean; Stalpaert, Georges

doi:10.1016/s0003-4975(10)61079-x

Cited by 51 publications

(4 citation statements)

References 35 publications

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“…The 19 prostheses which clotted give a mean incidence of thrombotic obstruction of 0-46 per 100 patient years (2.35% of the patients and 1-8% of the prostheses being affected). These figures compare favourably with the incidence of 1-17 per 100 patient years reported recently by Daenen et al 16 We considered several possible aetiological factors and compared their incidence in the group with thrombosed group valves and in the total group of patients who were followed up.…”

Section: Methodssupporting

confidence: 55%

Thrombotic obstruction of the Bjork-Shiley valve: the Glasgow experience.

Ryder¹,

Bradley²,

Brannan³

et al. 1984

Thorax

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ABsTRAcCT Thrombotic obstruction is the most feared complication of the Bjork-Shiley tilting disc prosthesis. From 1971 to 1982 1186 Bjork-Shiley valves were implanted in 900 patients. There were 93 deaths in hospital. Eight hundred and seven patients have been followed for a total of 4146 patient years; 14 patients were lost to follow up. Nineteen cases of thrombotic obstruction were identified at necropsy or at a repeat operation in the study group. The mitral prosthesis was thrombosed in 16 patients, the aortic in two, and the tricuspid in one. The incidence for this complication has been calculated to be 0-46 per 100 patient years for all valve positions, 0-79 for single mitral valve replacements, 0-18 for aortic replacements, and 0 63/100 for the tricuspid position. The maximum possible incidence of this complication in this population has been calculated to be 1-4 per 100 patient years. The mortality rate was 41-7% for reoperation and 63% for the development of the complication. Risk factors that have been identified are inadequate anticoagulant control, poor preoperative exercise capacity, and possibly also the implantation of small prostheses.The Bjork-Shiley tilting disc prosthesis is an extensively used mechanical valve of proved long term functional durability.' It is, however, vulnerable to rapidly progressive malfunction if thrombus forms on the valve and restricts the movement of the disc. The incidence of this complication has been reported in several series.'-'5 The figures are generally based on those patients who presented to hospital or who were operated on for the complication and may therefore represent only the "tip of the iceberg' of the true incidence of thombus formation. '5 We are fortunate in the West of Scotland in that demography and the centralisation of the cardiac surgical service enable us to follow our patients relatively closely. Follow up data have been analysed and we have used them, firstly, to estimate a possible range for the incidence of this complication within the population and, secondly, to elucidate the aetiology of the condition.Address for reprint requests: Dr S J Ryder, Department of Cardiac Surgery, Western Infirmary, Glasgow G11 6NT. Accepted 3 April 1984 Patients and methodsIn Glasgow during the years 1971-82, 1186 BjorkShiley valves were implanted in the 900 patients comprising this series. After operation a standard postoperative management and follow up regimen were used for all patients. Anticoagulant control (maintaining the thrombotest response at 5-10%) was achieved by the use of warfarin, which was started after the removal of the pericardial and mediastinal drains. In most cases this was by the evening of the first postoperative day. Heparin was not used routinely in the postoperative period. Anticoagulant control was achieved thereafter by regular attendance at an outpatient clinic. The patients also attended an outpatient clinic six weeks after operation for examination by a member of the surgical staff. They were then reviewed by medical and surgi...

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Section: Methodssupporting

confidence: 55%

Thrombotic obstruction of the Bjork-Shiley valve: the Glasgow experience.

Ryder¹,

Bradley²,

Brannan³

et al. 1984

Thorax

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“…However if one considers only the red o pa tients, th e perce ntage of par avalvular leaks in aortic regurgitation is 50 -100 % higher tha n in th e other group s. The annual incidence is 2%. and 4% for patients with acute ind ication and valvula r endo carditis (6,8,12,26).…”

Section: Discussionmentioning

confidence: 99%

Late Results of Prosthetic Valve Replacement for Aortic Regurgitation and the Prognostic Significance of the End-diastolic and Regurgitated Blood Volumes

Skupin

Klepzig²,

Beyersdorf³

et al. 1988

Thorac cardiovasc Surg

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Between January 1975 and December 1985 214 patients underwent prosthetic aortic valve replacement for isolated aortic regurgitation. Patient follow-up averaged 5.4 years after the operation (range 0.7-10.7 years). Preoperative staging showed 9 patients to be in NYHA stage II, 111 patients in stage III, and 94 patients in stage IV. At follow-up 3 patients complained of increased fatigue, 9 patients remained stable and 167 patients had improved. 103 of these patients were free of symptoms under stress, i.e. NYHA stage I. The hospital mortality was 3.7% (8/214 patients). An additional 26 patients died within an average of 2.8 years. The cumulative 5-year survival rate was 85%; the 10-year survival rate was 81.5%. 10 patients underwent a second operation within an average of 3.4 years. The correlation between the end-diastolic volume and the regurgitated blood volume has prognostic significance. 25 patients with appropriate enlargement of the left ventricle showed a significant decrease of the end-diastolic volume and the roentgenographic heart volume combined with an increase of ejection fraction. None of these 25 patients died from cardiac complications. A control group of 9 patients with myocardial damage showed no significant change in the above parameters. 4 patients in the control group died. We conclude that the relationship of regurgitated blood volume and the left ventricular end-diastolic volume is of prognostic significance for patients with chronic aortic regurgitation presenting with minimal symptoms.

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“…Although reoperation with either prosthetic valve replacement or debridement of the ex isting valve has been considered the custom ary treatment, morbidity and mortality rates are considerable, approaching 50% among patients with functional class III or IV symp toms necessitating emergent surgery [119][120][121][122][123], Thrombolytic therapy has been advo cated as a potential nonsurgical alternative for the treatment of prosthetic valve throm bosis. To date, the published experience in cludes 97 patients, all with mechanical pros thetic valve thrombosis (table 13).…”

Section: Prosthetic Valve Thrombosismentioning

confidence: 99%

Seminars in Thrombosis, Thrombolysis and Vascular Biology

1991

Cardiology

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In general terms, thrombotic disorders of the cardiovascular system are characterized by poorly regulated, nonphysiologic thrombus formation. Considered more specifically, however, pathologic thrombosis represents a critical imbalance, frequently at both the systemic and vascular levels, of coagulation, anticoagulation and fibrinolysis. Indeed, the balance is shifted toward coagulation, preventing normal physiologic blood flow. Anticoagulants have been a mainstay in the treatment of thrombotic disorders. However, emerging strategies have focused primarily on thrombus dissolution (fibrinolysis), which can be efficiently achieved with the administration of extrinsic plasminogen activators. Clearly, thrombolytic therapy is currently the most direct means of restoring blood flow, vital organ perfusion and hemostatic balance among patients with thrombotic disorders of the cardiovascular system.

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Nine Years' Experience with the Björk-Shiley Prosthetic Valve: Early and Late Results of 932 Valve Replacements

Cited by 51 publications

References 35 publications

Thrombotic obstruction of the Bjork-Shiley valve: the Glasgow experience.

Thrombotic obstruction of the Bjork-Shiley valve: the Glasgow experience.

Late Results of Prosthetic Valve Replacement for Aortic Regurgitation and the Prognostic Significance of the End-diastolic and Regurgitated Blood Volumes

Seminars in Thrombosis, Thrombolysis and Vascular Biology

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