Heart valve surgery in the United Kingdom: present practice and future trends.

Editorial Heart valve surgery in the United Kingdom: present practice and future trends The surgery of heart valve disease raises many questions. Should we conserve or replace the diseased valve? What should the replacement valve be-a homograft, a biopros-thetic valve, or a mechanical valve? Isn't valve disease becoming less common anyway? Test reports, clinical comparisons, and longitudinal follow up studies, particularly those focusing on the very latest artificial heart valve are reminiscent of car tests in motoring magazines-with the latest model, incorporating state of the art technology, giving superior performance (under manufacturer's test conditions) ... and costing just that bit more. This plethora ofscientific advice about which valve to choose can be confusing and individual reports are not necessarily widely representative or capable of extrapolation. Comprehensive information on the pattern ofoperations for heart valve replacement has been available on a national basis in the United Kingdom since 1986, when the United Kingdom Heart Valve Registry was established. This registry, funded by the Department of Health, receives data from all National Health Service cardiac surgical units in the United Kingdom and provides unique information on the changes in patient numbers, on demographics data, and on the preferred types of artificial valves currently being implanted by cardiac surgeons in the United Kingdom. Although the national registry cannot yet be expected to answer the vexed question, "what artificial heart valve should we use?", it already provides answers to other questions.