The use of biological heart valves

Types of prosthesis, durability and complications
Background: In the past, biological heart valve prostheses have been continuously further developed, catheter-assisted valve systems (TAVI, “transcatheter aortic valve implantation”) and minimally invasive application paths have been technically improved. Together, this has led to far-reaching changes in therapeutic strategies and an increase in the spectrum of patients for the implantation of biological aortic valves.
Methods: A selective literature search was conducted in PubMed with the search terms “conventional biological aortic prosthesis”, “rapid deployment prosthesis” and “transcatheter aortic valve implantation/replacement”.
Results: In the case of biological heart valve prostheses, a distinction is made between gestured (conventional, rapid deployment and catheter-supported) and non gestured prostheses. The long-term durability of conventionally surgically implantable biological valve prostheses is by far the best demonstrated: The re-operation rates after 15 years are between 13.4 % and 36.6 % and the rate of implantation of pacemakers is about 4 %. “Rapid deployment” prostheses combine the advantages of conventional and catheter techniques and facilitate minimally invasive approaches. The TAVI method is currently recommended for patients with a high and medium risk profile, while conventional valve replacement is the prosthesis of choice for patients in the low risk spectrum. The use of rapid deployment and TAVI prostheses is associated with an increased rate of pacemaker implantation compared to conventional prostheses. For TAVI this is 8.5-15.3 %, for rapid deployment valves between 6.0 and 8.8 %. The medium-term durability of the catheter-supported and rapid deployment prostheses is promising, but the long-term durability is currently still unclear.
Conclusion: The further development of biological prostheses in the form of improved conventional, catheter-supported and rapid-deployment prostheses allows more individualized treatment of patients, in which the R isikoprofile must be compared with the advantages and disadvantages of the prosthesis types in the Heart team.
Author(s)Source
Kueri, S; Kari, F A; Fuentes, R A; Sievers, H; Beyersdorf, F; Bothe, WDtsch Arztebl Int 2019; 116(25): 423-30; DOI: 10.3238/arztebl.2019.0423
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