The Use of Biological Heart Valves

Types of prosthesis, durability and complications

Background: Biological heart-valve prostheses have undergone continuous development
up to the present, and technological advances have been made in catheter-assisted valve systems (transcatheter aortic valve implantation, TAVI) and minimally invasive routes of application. These parallel trends have led to major changes in therapeutic strategies, widening the spectrum of patients who are candidates for biological aortic valve implantation.

Results: Among biological heart-valve prostheses, a distinction is drawn between stented (conventional, rapid-deployment, and catheter-assisted) and non-stented types. The long-term durability of conventional, surgically implantable biological valve protheses is by far the best documented: the reported 5-year reoperation rates range from 13.4% to 36.6%, and the pacemaker implantation rate is ca. 4%. Rapid-deployment prostheses combine the advantages of conventional and catheter-assisted techniques and facilitate minimally invasive approaches. The TAVI method is currently recommended for high- and intermediate-risk patients, while conventional valve replacement remains the method of choice for those at low risk. Rapid-deployment and TAVI prostheses is associated with a higher pacemaker implantation rate than conventional prostheses: these rates are 8.5–15.3% for TAVI and 6.0–8.8% for rapid-deployment valves. The intermediate-term durability of catheter-assisted and rapid-deployment prostheses appears promising, but their long-term durability is still unclear.

Conclusion: The further development of biological heart-valve prostheses in the form of improved conventional, transcatheter, and rapid-deployment prostheses now enables individualized treatment. Before any such procedure is performed, the cardiac team must assess the patient’s risk profile and the advantages and disadvantages of each type of prosthesis to determine which is best.

Kueri, S; Kari, F A; Fuentes, R A; Sievers, H; Beyersdorf, F; Bothe, WDtsch Arztebl Int 2019; 116: 423-30. DOI: 10.3238/arztebl.2019.0423
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