Thorac cardiovasc Surg 2000; 48(3): 175-182
DOI: 10.1055/s-2000-9641
Special Report
© Georg Thieme Verlag Stuttgart · New York

Standards and Concepts in Valve Surgery

A 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)F. Unger, W. G. Rainer, D. Horstkotte, P. Ghosh, W. Rutishauser, E. Braunwald, C. DuranC. Olin, D. A. Cooley, E. Bodor, B. Reichart,  R. Schistek, U. v. Oppell, W. Ade, J. Wada
  • European Heart Institute (EHI) of the European Academy of Sciences and Arts and the International Society of Cardiothoracic Surgeons (ISCTS)
Further Information

Publication History

Publication Date:
31 December 2000 (online)

1Introduction

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 [1] 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 [2].

References

Annex

Tables
ValveTypeIntroduced
1. Mechanical valves
Gottleaflet1963
Hufnagelball1963
Magovern-Cromieball1963
Kay-Susukidisc1964
Starr Edwards 1000ball1964
Starr Edwards 6000ball1964
Kay-Shileydisc1965
Smeloff Culterball1966
Starr Edwards 1200ball1966
Starr Edwards 6120ball1966
Cross-Jonesdisc1967
Harken P2disc1967
Starr Edwards 2300ball1967
Starr Edwards 6300ball1967
Wadadisc1967
Braunwald-Cutterball1968
Braunwald-Cutter/M/Tball1968
Starr Edwards 2310ball1968
Starr Edwards 6310ball1968
Starr Edwards 6500disc1968
Björk-Shiley TSDdisc1969
DeBakey-Surgitoolball1969
Starr Edwards 2320ball1970
Starr Edwards 6520disc1970
Cooley-Cutter/M/Tdisc1971
Starr Edwards 2400ball1972
Cooley-Cutterdisc1973
Bealldisc1974
Björk-Shileydisc1975
Lillehei-Kaster 500/300disc1975
Medtronic-Hall 7700/A,Mdisc1977
St. Jude Medicalbileaflet1977
Omnisciencedisc1978
Björk-Shiley MSdisc1981
Duromedicsbileafet1982
ValveTypeIntroduced
2. Biological valves
Shumway Angellfresh tissue1969
Hancockporcine1969
Zerbinidura mater1971
Carpentierporcine1975
Angell-Shileyporcine1976
Ionescu-Shileypericardium1976
Mitroflowpericardium1982
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
Ultracor
Macchi
Chitra
St. Vincents
GuangDeong
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

Prof. Dr. Felix Unger

President of EASA and EHI

Waagplatz 3

5020 Salzburg

Österreich