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Choice of prosthetic heart valve for adult patients

^* Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC + USC Medical Center, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA

View larger version (21K): [in a new window]   Figure 1 Mortality after aortic valve replacement (AVR) with the Bjork-Shiley and porcine valves from the Department of Veterans Affairs trial. From reference 6.

View larger version (21K): [in a new window]   Figure 2 Survival up to 30 years after prosthetic heart valve (PHV) replacement by the patient’s age at time of PHV implantation. From reference 22. For limitations of this study, see text.

View larger version (29K): [in a new window]   Figure 3 Thromboembolism rates for mechanical aortic valves. The vertical axis is the linearized rate in percentage per year. Each symbol represents one series. Circles indicate that only late events were used to calculate the rates; diamonds indicate that both early and late events were used. BS = Bjork Shiley; CM = Carbomedics; ET = Edwards Tekua or Duromedics; MH = Medtronic Hall; MS = Monostrut; OC = Omnicarbon; OPC = FDA’s Objective Performance Criteria (from reference 29); OS = Omniscience; SB = Sorbin Bicarbon; SE = Starr Edwards; SJ = St. Jude; UC = Ultracor. From reference 29.

View larger version (37K): [in a new window]   Figure 4 Freedom from structural valve degeneration with four types of biological valves with the superimposed Weibull distribution fits. Modified and adapted from reference 29.

View larger version (17K): [in a new window]   Figure 5 Estimated effective orifice area (prosthetic heart valve [PHV] area) of four different bioprosthesis based on manufacturer’s specifications for each valve size. Figure constructed from data in Table 1 in reference 42. Carpentier-Edwards (C-E) pericardial valve (line) has the largest PHV area in valve sizes 19 to 29 mm. Although the actual PHV areas after PHV insertion will be lower, starting with a larger valve area is an advantage that could be important. SAV = supra-annular valve.

View larger version (21K): [in a new window]   Figure 6 Failure-free rate of the Hancock modified orifice (MO) valve (from reference 16) and the stentless valve (from reference 44). "Porcine limits" are the limits of failure of stented bioprosthesis failure rates (from reference 43).

View larger version (32K): [in a new window]   Figure 7 Percentage actuarial freedom from cardiac events up to 15 years of the St. Jude 19- to 21-mm valves by the prosthetic heart valve (PHV) effective orifice area index (EOAi) (calculated from the echocardiographic/Doppler valve area obtained at time of hospital discharge after PHV insertion). Adapted from reference 55.

View larger version (28K): [in a new window]   Figure 8 An algorithm for choice of prosthetic heart valve. A/C = anticoagulation; AVR = aortic valve replacement; INR = international normalized ratio; MVR = mitral valve replacement.