Valve-in-valve prosthesis-late morphological findings.

Since its implantation in 2002, transcatheter aortic valve implantation (TAVI) has become the preferred intervention for patients with severe aortic stenosis and significant co-morbidities. In 2007, it was adopted as a rescue procedure for failed bioprosthetic valves, now known as the valve-in-valve (VIV) procedure. Unlike other modes of treatment with a multitude of phase 4 post-marketing surveillance (PMS) data, use of these valves have increased rapidly even without long term durability data on this procedure and the near lack of information on the pathology of failed transcatheter aortic valve replacement (TAVR) bioprosthesis and especially after the VIV procedure. We present a case of a late explanted VIV bioprosthesis (ten (10) years post-initial aortic valve replacement and five (5) years post-VIV procedure) in a 65-year-old male with multiple morphologic findings. Further availability of standardized morphologic data from explanted bioprosthetic valves is essential to aid in understanding the pathophysiology of tissue degeneration of the TAVI valve, and ultimately to improve patient outcomes by identifying possible early interventional strategies.

DeBakey Surgitool mechanical heart valve prosthesis, explanted at 32 years.

Contemporary mechanical heart value prostheses are expected to last "just about forever" or the patient's lifeline. They do however still suffer complications, some of which necessitate premature explantation. Complications today are mainly related to patient compliance with anticoagulant medication, infection and hemorrhage. The DeBakey Surgitool mechanical heart valve was the first such device to have Pyrolyte components. We present a DeBakey surgitool mechanical heart valve that was in place for 32 years! It was explanted for dysfunction related to tissue overgrowth and not to its related components. With good patient compliance, this mechanical heart valve prosthesis is an example of good prosthetic valve durability.

Performance of the Carpentier-Edwards SAV and Hancock-II porcine bioprostheses in aortic valve replacement.

BACKGROUND AND AIMS OF THE STUDY: Extended experiences of the Carpentier-Edwards Supra-Annular Valve (CE-SAV) and the Hancock II (H II) porcine bioprostheses were evaluated to determine the freedom from structural valve deterioration (SVD) by reoperation in the aortic position. METHODS: Between 1981 and 1994, 1,524 procedures (mean patient age 67.6+/-11.2 years) with the CE-SAV, and 670 procedures (mean patient age 65.2+/-12.1 years) with the H II were conducted at the University of British Columbia and University of Toronto, respectively. The patient populations were differentiated by mean age, gender and valve size, but not by concomitant coronary artery bypass. The analyses included actuarial and actual freedom from SVD and evaluation of predictors of SVD. RESULTS: Actuarial freedom from SVD at 15 years for patients aged > or =65 years was 91.5+/-2.9% for CE-SAV, and 100% for H II (p = NS), while the actual freedom was 96.4+/-1.0% and 100%, respectively. For the patient population aged 66-70 years, the actuarial freedom from SVD was 87.0+/-6.0% for CE-SAV and 100% for H II (p = NS), while the actual rates were 93.6+/-2.3% and 100%, respectively. For the population aged >70 years, the actuarial freedom from SVD was 96.9+/-1.5% for CE-SAV, and 100% for H II (p = NS), while the actual freedom was 98.8+/-0.5% and 100%, respectively. In the patient population aged <65 years, the actuarial freedom from SVD at 15 years favored the H II (p = 0.04), and the actual freedom showed the same outcome. The valve type was not predictive of SVD for age groups < or =60 years, >60 years, 61-70 years and >70 years, but was predictive for the overall population (p = 0.03), as was age and previous valve replacement. CONCLUSION: The CE-SAV and Hancock II both provide satisfactory clinical performances, with a low incidence of SVD, and no significant difference in SVD was shown in patients aged > or =65, 66-70, or >70 years. There is a trend to less SVD by actual analysis for the Hancock II in patients aged <65 years. This evaluation must be considered as work-in-progress because of the limited number of patients at risk at 15 years, especially with the Hancock II prosthesis.