Advancing the Technology of Bileaflet Mechanical Heart Valves

Transcription

1 Advancing the Technology of Bileaflet Mechanical Heart Valves

2 A. Krian. J. M. Matloff D. M. Nicoloff Editors Advancing the Technology of Bileaflet Mechanical Heart Valves

3 Editors' addresses: Prof. Dr. med. Arno Krian Clinic for Thoracic and Cardiovascular Surgery Heart Center Duisburg Gerrickstr. 21 D Duisburg, Germany Dr. J. M. Matloff 511 So Lucerne Blvd Los Angeles, CA 90020, USA Dr. D. M. Nicoloff Cardiac Surgical Associates P.A. 920 East 28th Street, *' 420 Minneapolis, MN 55407, USA Die Deutsche Bibliothek - CIP-Einheitsaufnahme Advancing the technology of bileatlet mechanical heart valves / A. Krian... - Darmstadt: Steinkopff ; New York; Berlin; Heidelberg; London; Paris; Tokyo; Hong Kong; Barcelona; Budapest: Springer, 1998 ISBN-13: DOl: / e-isbn-13: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Steinkopff Verlag. Violations are liable for prosecution under the German Copyright Law by Dr. Dietrich SteinkopffVeriag GmbH & Co. KG, Darmstadt Softcover reprint of the hardcover 1 st edition 1998 Medical Editor: Beate Riihlemann - English Editor: Mary Gossen - Production: Heinz J. Schafer Cover Design: Erich Kirchner, Heidelberg The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting: Typoservice, Griesheim Printed on acid-free paper

4 Preface Cardiac valvular surgery has evolved over the past 50 years. The desired characteristics for valve substitutes were defined by Harken and other pioneers in the early 1960's. They include: hemodynamic efficiency (minimal resistance to forward flow and absent or minimal regurgitant flow); durability paralleling the patient's lifetime; ease of technical insertion in the natural anatomic location; biocompatibility in regard to minimal hemolysis, thromboembolism/thrombosis and patient awareness; and the prospect of improving the patient's overall quality of life. Over the past 20 years, considerable progress has been made with regard to materials development and mechanical design, especially as embodied in the pyrolytic carbon, bileaflet design. These technologic advances have resulted in more "normal" hemodynamic performance, significantly improved durability, and progressive advances in biocompatibility. The results of cardiac valve replacement surgery in general and mechanical valve replacement in particular have also been improved by other considerations that include: improved techniques for myocardial preservation during surgery; the development of valve preserving techniques in the atrioventricular location; better understanding of the use of anticoagulants; and, more recently, the availability of lesser invasive approaches in cardiac surgery. As a result of these multiple improvements in the science of cardiac valve surgery, patients with advanced degrees of native valvular dysfunction can anticipate not only significantly increased longevity but a quality of life that is far beyond our earlier goals of survival and improvement in New York Heart Association Classification. Increasingly, patients are achieving clinical outcomes that are event-free, with a coincident economic/financial outcome that allows the use of constrained resources to be extended, on a cost-effectiveness basis, to more patients around the world. The old adage that valve replacement surgery amounted to replacing one disease process with another no longer holds. "Advancing the Technology of Bileaflet Mechanical Heart Valves" addresses, from a global perspective, most of these advances in the important therapeutic endeavor of cardiac valve disease and its correction. In particular, the evolving clinical experience with a new open pivot, bileaflet, pyrolytic mechanical valve is the frame of reference for assessing how well we have done in confronting the problems of valvular heart disease over the past 50 years. We would like to acknowledge the contributions of each of the authors published herein as well as the other participants in the Naples Symposium on the ATS Medical heart valve. Their progressive spirit and active approach to cardiac surgery assures us all that the standard will continue to be advanced. We hope that by reading this book it will translate to improving the outcomes of your own patients. Dr. Amo Krian Dr. Jack M. Matloff Dr. Demetre M. Nicoloff

5 Contents Preface V Anticoagulation problems Optimization of oral anticoagulation: solved and unsolved problems with mechanical heart valve prostheses Horstkotte, D., C. Piper, M. Wiemer, H. P. Schultheiss... 1 ESCAT - Early self-controlled anticoagulation trial Korfer, R., H. KOTtke Anticoagulation revised for mechanical ATS heart valve implauts Van Nooten, G., Y. VanBelleghem,F. Caes, K. Franc;;ois,D. Goossens, D. M. Nicoloff Clinical results and surgical techniques Ministry of health and welfare study for the ATS medical bileaflet valve in Japan Shiono, M., Y. Sezai,A. Sezai, R. Omoto, S. Kyo,M. Hatanaka, S. Kitamura, K. Kawachi, J. Hasegawa, K. Kawazoe, T. Sasaki Clinical evaluation oftheats Medical valve Kim, H. J., W. J. Kim, W. M. Jo, T. S. Kim, Y. S. Sohn, Y. H. Choi 47 Clinical results of a large series of ATS valve implants Krian,A The Oxford experience with the ATS valve Westaby, S Queensland/Australian experience with the ATS mechanical valve November 1996 Tesar, P. J., M. F. O'Brien, T. K. Mau, P. G. Pohlner Our experience with theats Medical mechanical valve prosthesis in the tricuspid position de Vega, N. G., J. Gutierrez, G. F. Madero, E. G. Cocina The ATS valve in children PreiS, M., D. Georgiadis, Y. Gybels, A. Lindner, H. Sommer, 1. Konzag, G. Wagner, S. Zierz, H.-R. Zerkowski ATS Medical mechanical valve prosthesis in reoperations Fraile, J., J. Martinell, V. Artiz, C. F. Kizner, J. M. Arribas, B. Vifials, J. Moya, J. G. Puente

6 VIII Contents Echocardiographic evaluations ATS prosthetic valves AP series: echo cardiographic evaluation Parravicini, R., M. Barchetti L. Reggianini, F. Cocconcelli, N.AsgharnejadFahim, G. Cerioli, M. E.Amorth, G. Zobbi, G. P. Belloni, M. Tonelli Echo and doppler controlled behavior of aortic ATS valve comparison with the aortic SJM Villemot, J. P., P. Perlot, J. P. Carteaux, N. Salti, N. Bischoff, K. Tzvetanov 117 ATS valve: Early experience and comments on the significance of "HITS" in patients with prosthetic heart valves Faichney, A., D. G. Grosset, E. S. Wilson, E. Brodie Special techniques Minimally invasive direct coronary artery grafting (MIDeAB) Emery, R. w., A. M. Emery, K. V. Arom