Elective Operative mortality
is approximately 2%, but this is increased in patients
with IHD (when it is usually combined
with CABG), lung disease
and the elderly.
- Cardiac valves both tissue and metal are used to replace diseased, damaged and infected valves
- May be metal valves or tissue valves (Xenografts and allografts)
Xenografts and allografts
- Either from pig or bovine heart
- Generally do not require lifelong anticoagulation
- Remain functional for 10-15 years so maybe preferred in elderly
- Porcine aortic tissue valves usually produce no abnormal added sounds.
- Porcine mitral may cause a diastolic flow murmur and opening snap.
- The caged ball valve (Starr-Edwards)
- The tilting disc (single leaflet) valve, and the bi leaflet valve
- Most mechanical valves will remain functional for 20-30 years
- Require Warfarinisation so avoided in those who cannot take Warfarin
- Heparin may be used instead in some cases for short term treatment
- Those in whom Warfarin required - AF
- Valve replacement provides marked symptomatic relief
and improvement in survival.
- Endocarditis early < 60 days related to operation
- Endocarditis late > 60 days post operative typical endocarditis type organisms.
- Most prosthetic valve endocarditis requires valve removal and reoperation.
- Valve failure - mitral valves and younger patients more prone
- Embolisation - mitral and caged valves more so
- Valve Thrombosis - replace valve
- Anaemia and haemolysis
- Arrhythmias also occur.
- Endocarditis: all prosthetic valves require antibiotic prophylaxis against
infective endocarditis during non-sterile procedures, e.g.
dental treatment, lower gastrointestinal or urogenital procedures
- Anticoagulation for metal valves with Warfarin (NOACS not licensed)