Valvular heart disease: a perspective
SH Rahimtoola
Valve replacement has been one of the most important advances in the management of patients with valvular heart disease. The 10 and 15 year survival rate after isolated aortic and mitral valve replacement with the Starr-Edwards valve is 56 and 44%, respectively. At 5 and 7 years, survival with the Bjork-Shiley, porcine bioprosthesis and the Starr-Edwards valve is similar. Patients operated on during the last 5 to 10 years have a much better survival rate than those operated on in the 1960s; therefore, the 10 and 15 year survival of those operated on recently should improve. All patients with a mechanical prosthesis need long-term anticoagulant therapy with drugs of the coumadin type. Porcine bioprostheses have a low failure rate up to 5 years after valve replacement; after this, valve failure occurs at an increasing rate, but the incidence at 10 and 15 years is not known. Valve replacement usually produces a marked improvement in the symptomatic status of the patient because of improved hemodynamics; ventricular function is improved in selected subsets of patients. The role of long-term vasodilator therapy has not been fully determined. Antibiotic prophylaxis for secondary prevention of rheumatic carditis and for prevention of infective endocarditis is important.
