Choices in Valve Replacement - Desun Hospital Health Insights
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Desun Hospital Health Insights
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Choices in Valve Replacement - Desun Hospital Health Insights
- 1. C H O I C E O F H E A R T V A L V E S Criteria for patient selection Presented by Public Awareness Program
- 11. What kinds of heart valves are available? Bioprosthetic Valves Mechanical Valves How do you choose between these valves?
- 15. Current Trends in Valve Implants Tissue valves have become more accepted in the U.S. due to concerns about quality of life and improved durability. Mechanical valves, however, still compose a large part of valve implants, particularly in younger patients. U.S. Implant Trends Mechanical vs Tissue Valve Implants Mechanical 45% Tissue 55%
- 16. Indian Scenario
- 18. St. Jude Medical Tissue valve usage
- 20. Mechanical Prosthesis Cost Analysis : Anticoagulantion therapy INR Test every 15-30 days No. of visits to Physicians Thrombolysis Treatment of Hemorrhage/Struck Valve Repeated Hospitalization
- 22. Choice of Valve The Patient Age Gender Compliance Concomitant Illness Lifestyle Cost Medical services
- 23. Choice of Valve Indian Scenario : Rheumatic Heart Disease Children & Young Males & Females Rural & Remote Illiteracy & Poverty Ignorance
- 24. Choice of Valve in Children Mechanical Prosthesis Advantages
- 30. If I Need A Valve Surgery VALVE REPAIR Follow Up Leave it to the Cardiologist
- 31. If Valve Needs to be Replaced TISSUE VALVE ( Young female, old life exp<20 yrs) No major Follow Up Re do after 10-15 yrs
- 32. If tissue valve cannot be used MECHANICAL VALVE ( young patient, poor, not ready for re op) Regular Follow Up Required Compromised lifestyle Lifetime anticoagulation required
- 33. Decisions to make Is Lifestyle Important?
- 34. Thank You!
Editor's Notes
- Dwight Harken began the modern era of prosthetic valve replacement by insertion of his double cage-ball valve into the aortic orifice below the coronary ostia following excision of the diseased cusps. Some of his patients were still alive after 20 years. Albert Starr, a physician, and Lowell Edwards, an electrical engineer, simplified the caged-ball valve by using a single titanium cage, a silastic ball, and a sewing ring covered with teflon. The Starr-Edwards valve was first implanted in the mitral position in 1960, and leter in the aortic position. It became commercially available in 1965. The sewing ring made it easy to suture silastic ball had a tendency to absorb liquid and become deformed, sometimes jamming central flow obstruction cause high pressure gradients, especially in patients with a narrow aortic root
- Jerome Kay, a surgeon, and Donald Shiley, and engineer, introduced a low-profile disc valve for use in the mitral position. Some surgeons used it in the aortic position too, because, unlike the caged-ball valve, the disc did not extend into the supravalvular ridge; high valvular gradients were still present; valve was subject to wear and thrombosis Other sliding disc configurations were also developed
- Juro Wado (Japan) developed a tilting disc valve with teflon hinges and an opening angle of 80 degrees; the tilting disc brought down pressure gradients; the teflon hinges wore out Shiley and Dr. Viking Bjork developed a hingeless low-profile tilting disc valve made of Delrin, and designed with an opening angle of 60 degrees. The Bjork-Shiley disk was used successfully in the aortic and mitral position.
- Examples of failed valves: - crack in the silastic rubber ball - thrombus on the valve housing - wear on the post’s fabric covering - strut failure of a Bjork-Shiley valve (valve model was recalled, then redesigned as a monostrut to avoid this problem) NOTE: patient with this valve survived the failure