Ji. Fann et Ta. Burdon, Are the indications for tissue valves different in 2001 and how do we communicate these changes to our cardiology colleagues?, CURR OPIN C, 16(2), 2001, pp. 126-135
The indications for tissue valves in the aortic and mitral positions are be
coming better defined with advances in valve design, valve preservation, an
d management of reoperations. Although some patients who require cardiac va
lve replacement clearly benefit more from one type of valve than from anoth
er, not infrequently one encounters a patient who is in the "gray zone," wh
ere the optimal choice is difficult. At present, bioprostheses for the dise
ased aortic valve include stented porcine and pericardial valves, stentless
porcine valves, aortic homograft, and pulmonary autograft. For patients wi
th mitral valve disease, options for tissue valve replacement are a stented
porcine or pericardial prosthesis. Generally, factors to consider in choos
ing the appropriate valve substitute include the patient's age, expected li
fe expectancy, coexisting medical problems, lifestyle, and socioeconomics;
the etiology of the valve disease, annular size, and physician and patient
preference are also relevant. Despite the known finite durability of tissue
valves, which is the main limitation in their use, the long-term results h
ave been satisfactory, particularly in older patients, patients with a limi
ted life expectancy, and those undergoing valve replacement in the aortic p
osition. Distillation of available information and ongoing communication be
tween the surgeon and the cardiologist will enable us to assist the patient
in choosing the best valve substitute. Curr Opin Cardiol 2001, 16:126-135
(C) 2001 Lippincott Williams & Wilkins, Inc.