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Biologic
Valves: Built to Last
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Carpentier-Edwards
PERIMOUNT Aortic Pericardial Biologic valve
(posted with permission)
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Heart valves are marvels
of natural engineering. Most people's last a lifetime. But when valves
go bad, they may need to be repaired or replaced. Almost 90,0001
Americans a year need surgery for valve disease. Many of these people
will get new, replacement valves made of mechanical or biologic (animal)
materials. Which type of valve they get is an important decision and is
often not decided until the time of surgery.
Up until now, the
biologic valve had one big disadvantage: it didn't last very long. Recently,
however, Cleveland Clinic Heart Center researchers have turned that belief
on its head. The biologic valve turns out to be a lot tougher than many
people thought.
Mechanical valves
are known to be very sturdy. They are made of carbon covered with polyester
mesh, and are practically indestructible. The big drawback is that patients
who get this type of valve also need to take special blood thinners for
the rest of their lives. Biological valves, by contrast, are made of specially
processed and shaped animal tissue. They don't require the patient to
take the blood thinners forever (unless they have other conditions which
warrant it). On the other hand, surgeons were hesitant to implant them
in patients who were much younger than 60. It was thought that they would
wear out long before the patient did.
That belief has now
been challenged. Heart Center researchers Michael Banbury, M.D., Delos
Cosgrove, M.D., James Thomas, M.D., and others2, discovered
that patients who had received biologic heart valves, did very well. Even
17 years later.
The Heart Center researchers
studied 267 patients who had received a Carpentier-Edwards aortic pericardial
valve replacement between 1981 and 1983. The researchers followed up on
these patients every year thereafter. Many patients not only got echocardiograms,
they filled out questionnaires. Outcome measurements included improvements
or declines in the New York Heart Association classification of clinical
symptoms and echo measurements to determine performance of the valve and
size of the valve opening.
How did they do?
According
to Dr. Banbury, after 17 years they were doing very well. The majority
of patients, even with an increasing age enjoyed good functional status.
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Michael Banbury,
M.D.
Cleveland Clinic Heart Center, Department of Cardiovascular Surgery
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"The hemodynamic durability
of this valve is excellent and resilient over time," says Dr. Banbury.
"The findings from this study support its use in patients and may be considered
for individuals younger than 65 years."
References:
- American Heart
Association, 2001 Heart and Stroke Statistical Update, http://www.americanheart.org/statistics/medical.html
( a
new browser window will open with this link. The inclusion of links
to other web sites does not imply any endorsement of the material on
the web sites or any association with their operators)
- Banbury MK, Cosgrove DM 3rd, Thomas JD, Blackstone EH, Rajeswaran J, Okies JE, Frater RM. Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg. 2002 May;73(5):1460-5
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