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Prosthetic Heart Valves

Prosthetic Heart Valves is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

The choice of valve prosthesis depends on many factors including the patient, surgeon, cardiologist, and clinical scenario. With improvements in bioprosthetic valves, the recommendation for a mechanical valve in patients <65 years of age is no longer as firm, and bioprosthetic valve use has increased in younger patients.

  • Mechanical
    • Ball-and-cage (Starr-Edwards): rarely, if ever, used today
    • Bileaflet (i.e., St. Jude, Carbomedics): most commonly used
    • Single tilting disk (i.e., Björk-Shiley, Medtronic Hall, Omnicarbon)
    • Advantages: structurally stable, long lasting, relatively hemodynamically efficient (particularly bileaflet)
    • Disadvantages: need for anticoagulation, risk of bleeding, risk of thrombosis/embolism despite anticoagulation, severe hemodynamic compromise if disk thrombosis or immobility occurs (single tilting disk), risk of endocarditis
  • Bioprosthetic
    • Porcine aortic valve tissue (i.e., Hancock, Carpentier-Edwards)
    • Bovine pericardial tissue (i.e., Carpentier-Edwards Perimount)
    • Advantages: no need for anticoagulation, low thromboembolism risk, low risk of catastrophic valve failure
    • Disadvantages: structural valve deterioration, imperfect hemodynamic efficiency, risk of endocarditis, still a small risk (0.7% per year) of thromboembolism without anticoagulation
  • Homograft (cadaveric)

    Rarely used for atrioventricular surgery; most commonly used to replace the pulmonic valve

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Citation

Williams, Dominique, et al., editors. "Prosthetic Heart Valves." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602448/all/Prosthetic_Heart_Valves.
Prosthetic Heart Valves. In: Williams D, Ramgopal R, Gdowski M, et al, eds. Washington Manual of Medical Therapeutics. 35th ed. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602448/all/Prosthetic_Heart_Valves. Accessed May 20, 2019.
Prosthetic Heart Valves. (2016). In Williams, D., Ramgopal, R., Gdowski, M., Dretler, A., & Bhat, P. (Eds.), Washington Manual of Medical Therapeutics. Available from https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602448/all/Prosthetic_Heart_Valves
Prosthetic Heart Valves [Internet]. In: Williams D, Ramgopal R, Gdowski M, Dretler A, Bhat P, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2019 May 20]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602448/all/Prosthetic_Heart_Valves.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Prosthetic Heart Valves ID - 602448 ED - Williams,Dominique, ED - Ramgopal,Rajeev, ED - Gdowski,Mark, ED - Dretler,Alexandra, ED - Bhat,Pavat, BT - Washington Manual of Medical Therapeutics UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602448/all/Prosthetic_Heart_Valves PB - Wolters Kluwer Health ET - 35 DB - Washington Manual DP - Unbound Medicine ER -