Surgery For Valvular Heart Diseases : Here To Stay

The first artificial heart valves to be used clinically were mechanical devices and the continuous research and development over the last 25 years led to the modern prostheses which offer simplicity and safety of implantation, haemodynamic efficiency, lower rates of thromboembolism and excellent durability. After the old Starr-Edwards ball-and-cage valve and the Björk-Shiley tilting-disk valve, both off the market now, the first prosthesis to show haemodynamic efficiency and low embolic rate was a single tilting-disc model, the Medtonic Hall valve, introduced in 1977. This prosthesis has proven efficient, reliable and durable and remains our preferred valve substitute. The St. Jude Medical (SJM) prosthesis, a bileaflet design was introduced at about the same time and gained the preference of most surgeons in the world. This valve demonstrated low gradients, minimal insufficiency, and low rates of thromboembolism (TE) [1]. Anticoagulation continued to be necessary but to a lesser extent than with previous designs [2]. Because of its low-profile and lesser need for special annular orientation, surgical implant was further simplified.