All patients receiving any heart valve implant have suffered from valve disease. Thus, they need appropriate ongoing medical care, which may include anticoagulation, blood pressure control, management of heart failure, diabetes, weight reduction, etc. Given the excellence of the Sorin Group mechanical heart valve, it is unlikely that it will fail structurally and it should last a lifetime. All tissue valves will ultimately suffer tissue alteration and the valve may deteriorate and fail, but this process is gradual and can be identified and managed. Life expectancy depends on the type of valve and patient factors. There is extensive information available to enable patient and advising physician to make an appropriate and individual decision regarding the choice of valve to be used.
- 21. What is the life expectancy of a patient with a mechanical valve vs. one with a tissue valve?
- 22. What are the potential complications associated with a biological valve?
- 23. What are the conditions for paravalvular leak? Can my patient develop a paravalvular leak months or years after implant?
- 24. What are the anticoagulation recommendations for the Sorin Group biological heart valves?
- 25. What are the advantages of the Sorin Group biological heart valves?
- 26. What are the advantages and disadvantages of biological valves?
- 27. What are my options in heart valve replacement?
- 28. My Sorin Group Biological Valve patient has a high gradient. What should I do?
- 29. Is it possible that I will be allergic to the materials in the Sorin Group biological heart valves?
- 30. Is it OK to have the valve canted in the annulus?
What is the life expectancy of a patient with a mechanical valve vs. one with a tissue valve?
What are the potential complications associated with a biological valve?
The principal complications that have been reported for bioprosthetic cardiac valves include, but are not limited to , valvular stenosis, valvular and perivalvular insufficiency, calcification, fibrosis, haemolysis, leaflet perforation, rupture or creep, infection, and valve contamination.
What are the conditions for paravalvular leak? Can my patient develop a paravalvular leak months or years after implant?
Paravalvular leaks may occur at any stage after valve implantation , but are most common in the first six postoperative months, with the exception of leaks due to endocarditis, which may occur at any time. Modern echocardiographic systems often reveal leaks in the immediate postoperative period, but the vast majority of these disappear within days. Paravalvular leaks related to surgical technique, or patient related factors , such as annular calcification, pathology of the connective tissue of the aortic or atrio-ventricular annulus or infection, must be assessed clinically and by non-invasive and/or invasive study , and may or may not need surgical intervention. Intravascular hemolysis due to red cell damage may be overt or sub clinical. Major leaks causing hemodynamic instability may not be obvious clinically - it is mandatory to assess unstable patients by transesophageal echocardiography.
What are the anticoagulation recommendations for the Sorin Group biological heart valves?
Extensive published data suggests that some form of anticoagulation therapy may be beneficial after bioprosthetic cardiac valve replacement in order to reduce the risk of thromboembolic phenomena. In general, for bioprostheses, consideration should be given to anticoagulation therapy for 30 to 60 days after aortic replacement. For patients with moderate to severe atrial enlargement, atrial fibrillation, left atrial thrombus, left atrial wall calcification or other atrial wall abnormalties, or a prior history of thromboembolic events, consideration should be given to prescribing indefinite anticoagulation therapy.
What are the advantages of the Sorin Group biological heart valves?
The primary advantages of the Sorin Group biological heart valves are performance and durability. The Sorin Group biological heart valves provide an excellent hemodynamic performance and a reduced need for long cross-clamp time and complex implantation technique. The unique mounting of the pericardium on the outside of the stent allows for maximum valve opening and optimum blood flow. The sewing cuff allows placement in small aortic annuli, resulting in excellent hemodynamics. The valve can be inserted within or above the annulus.
What are the advantages and disadvantages of biological valves?
Biological valves closely resemble natural valves in both form and function. They do not require ongoing anticoagulation medication and may provide a better quality of life for the patient. A key disadvantage of tissue valves is their low durability. Since the valves are similar to native valves, they are prone to the same disease characteristics. Valve leaflets can wear out and calcify, impairing the functionality of the valve, resulting in re-operation and valve replacement.
What are my options in heart valve replacement?
When a patient needs a heart valve replacement, two types are available, mechanical and tissue. Tissue valves are made of either cow (bovine) tissue or pig (porcine) tissue. Mechanical valves are made from materials such as carbon-coated graphite, metal, or plastics.
My Sorin Group Biological Valve patient has a high gradient. What should I do?
You should determine that the leaflets are operating properly and that flow is not occluded by pannus, a vegetation, or some other physical blockage. New valve patients often exhibit gradients that exceed the manufacturer's specification. These gradients are often the result of subvalvular narrowing of the outflow tract due to hypertrophy. You can expect the gradient to diminish over the year following the surgery as the hypertrophy regresses. The problem of the left ventricular outflow dynamic gradient is especially common in patients with aortic stenosis, left ventricular and/or septal hypertrophy and a normal or raised ejection fraction. It is essential to obtain correct and optimal echocardiographic views of the left ventricular outflow tract in calculating indices of valve function and to correct for body surface area to normalize the indices and assess possible valve/patient biological mismatch.
Is it possible that I will be allergic to the materials in the Sorin Group biological heart valves?
It is very unlikely. However, if you suspect that you might be allergic to polyester, acetal homopolymer, acetyl copolymer, glutaraldehyde, formaldehyde, silicone elastomer, or animal tissue, you should discuss it with your surgeon who may arrange for testing prior to your surgery.
Is it OK to have the valve canted in the annulus?
It is recommended that the valve be aligned with the blood flow. A canted valve creates more work for the heart by redirecting the flow. Flow forced to follow an irregular path creates greater stress on the blood cells that could activate thrombosis. Finally, flow directed against the wall of the aorta can cause endothelial damage and scarring.