RT Book, Section
A1 Chikwe, Joanna
A1 Castillo, Javier G.
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1161731870
T1 PROSTHETIC HEART VALVES
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accesscardiology.mhmedical.com/content.aspx?aid=1161731870
RD 2024/04/19
AB The  burden  of  valvular  heart  disease  leads  to  over  300,000  heart  valve  replacements  each  year  worldwide.1  This  number  will  probably  triple  by  2050,  and  valvular  heart  disease  will  likely  be  considered  as  the  future  next  cardiac  epidemic.2  Despite  tireless  efforts  and  perseverance  from  engineers  and  cardiovascular  specialists,  valve  replacement  still  lacks  an  ideal  therapy.  In  the  1950s,  Dwight  Harken  coined  the  "Ten  Commandments"  for  the  perfect  prosthetic  heart  valve.3  The  optimal  heart  valve  prosthesis  would  have  endless  durability,  absence  of  thrombogenicity  to  avoid  anticoagulation,  and  no  inherent  postoperative  gradient.  However,  almost  70  years  later,  there  is  still  no  perfect  valve  substitute4:  those  patients  who  undergo  heart  valve  replacement  exchange  valvular  heart  disease  for  prosthetic  heart  valve  disease.5  The  most  influential  factors  affecting  prosthesis  selection  include  the  individual  surgical  risk,  the  estimated  life  expectancy,  barriers  to  lifelong  anticoagulation,  and  the  patient’s  personal  preference.  The  latter  must  be  based  on  an  informed  understanding  of  the  trade-offs  between  the  incremental  risk  of  thromboembolic  and  hemorrhagic  complications  associated  with  mechanical  valve  replacement  and  lifelong  anticoagulation,  versus  the  risk  of  reoperation  for  structural  valve  degeneration  associated  with  bioprosthetic  valve  replacement.5,6  Management  of  patients  with  prosthetic  heart  valves  consists  of  surveillance  and  prophylaxis,  both  focused  on  prevention  and  diagnosis  of  the  major  complications  associated  with  prosthetic  heart  valves.  Patient  outcomes  continue  to  improve  after  valve  replacement  thanks  to  clinical  and  technical  developments:  in  the  field  of  surgical  valve  replacement,  these  developments  have  been  characterized  in  recent  years  by  steady  incremental  progress,  contrasting  sharply  with  the  rapid  technological  evolution7  and  uptake  of  transcatheter  valve  replacement,  a  difference  that  will  likely  define  this  field.8,9