Standards and Concepts in Valve SurgeryA report of the task force of European Heart Institute (EHI) of the European Academy of Sciences and Arts and the International Society of Cardiothoracic Surgeons (ISCTS)
31 December 2000 (online)
With the advent of open heart surgery, it has been possible to actively fight valvular diseases. Before World War II, there were some reports of operations on the heart, but these operations were rare and anecdotal. Closed techniques were performed occasionally in mitral surgery after World War II. After 1952, a major breakthrough occurred with the introduction of artificial valves and coronary artery bypass graft (CABG) surgery for open heart surgery.
Standards are technical specifications that ensure all procedures are understood and widely accepted. Concepts are abstract ideas or new developments that may become standards if widely accepted. The first artificial valves were designed in the 1950s as ball valves, and later as monoleaflet and bileaflet valves in aortic and mitral positions. Biological valves were developed in the 1960s. Open-valve reconstruction and other techniques were introduced in the late 60s. These techniques were used first for mitral stenosis and later for mitral regurgitation and homografts.
The standard for valve replacement is to use extracorporeal circulation (ECC) with myocardial protection. In most cases, reconstruction of the diseased valve will not result in good long-term results. Therefore, replacement with an artificial valve is preferred. Concomitant bypass surgery as indicated is performed. Device selection remains a challenge and must be tailored to the patient in conjunction with valve surgery. There are concepts in reconstructing the aortic valve as well as in designing new valves.
The management, including diagnostic and postoperative treatment, of patients with valvular diseases is complex. Valve selection can play an important role in the long-term outcome.
The following standards are set for surgeons:
Indication and Postoperative management.
A previous task force of the American College of Cardiology and the American Heart Association  gave an excellent basis for classifying and fostering a useful terminology for cardiac surgeons and cardiologists. Demographics, life span, and epidemiologic characteristics of disease have changed globally in the last 30 years. The availability of cardiac surgery worldwide is highly variable and discrepant, with the USA and Europe offering more accessibility to open heart surgery facilities .
- 1 Bonow R O, Carabello B. et al . Guidelines for the Management of Patients with Valuvlar Heart Disease. ACC/AHA Task Force on Practice Guidelines. Circulation.. 1998; 98 1949-84
- 2 Unger F. Worldwide Survey on Cardiac Interventions 1995. Cor Europaeum.. 1999; 7 128-46
- 3 Jamieson W RE, Edwards F H. et al . Risk Stratification for Cardiac Valve Replacement: STS National Cardiac Surgery Database. Ann Thorac Surg.. 1999; 67 943-51
|1. Mechanical valves|
|Starr Edwards 1000||ball||1964|
|Starr Edwards 6000||ball||1964|
|Starr Edwards 1200||ball||1966|
|Starr Edwards 6120||ball||1966|
|Starr Edwards 2300||ball||1967|
|Starr Edwards 6300||ball||1967|
|Starr Edwards 2310||ball||1968|
|Starr Edwards 6310||ball||1968|
|Starr Edwards 6500||disc||1968|
|Starr Edwards 2320||ball||1970|
|Starr Edwards 6520||disc||1970|
|Starr Edwards 2400||ball||1972|
|St. Jude Medical||bileaflet||1977|
|2. Biological valves|
|Shumway Angell||fresh tissue||1969|
|3. Valves in current use|
|I. Mechanical valves|
|Medtronic||- Medtronic Hall|
|St. Jude Medical||- Standard, HP, Regent, Masters|
|Sulzer||- Carbomedics, Top Hat, Sumit|
|Medical Carbon Research Inc.||- On-X|
|ATS Medical Inc.||- ATS|
|Sorin||- Monocast, Carbocast, Bicarbon|
|Baxter||- Starr-Edwards, Tekna, Mira|
|Medical Inc.||- Omniscience, Omnicarbon|
|II. Biological Valves|
|St Jude Medical||- Toronto SPV, Epic, Biocor|
|Medtronic||- Freestyle, Mosaic, Intact, Hancock II|
|Baxter||- Perimount, Carpentier-Edwards|
|Cryolife||- O'Brien, Ross|
|Sulzer||- Synergy, Mitroflow, Labcor|