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Eur J Cardiothorac Surg 2005;28:843-844
© 2005 Elsevier Science NL

Editorial comment

How much can we do to reach the ideal valve prosthesis?

Cardiothoracic Surgery, University Hospital, Coimbra, Portugal

(Email: antunes.cct.huc@sapo.pt).

The first 20% of the full text of this article appears below.

Since the introduction of the first prosthetic heart valve for orthotopic implantation, by Starr and Edwards in the early sixties, a countless number of devices have been created, marketed and used clinically. Many have not stood the test of time and some even constituted true clinical disasters with serious consequences for the patients. The most notorious was the problem of strut fracture of the initial models of the Björk–Shiley C–C valve, in the 1980s, which caused the death of many patients and obliged to elective reoperation for substitution of the prosthesis in many others, and resulted in a major legal battle and compensation to the patients which eventually led to the disappearance of the manufacturers.

A much more recent problem was that of the St. Jude Silzone valve (St. Jude Medical, Minneapolis, MN, USA). This prosthesis was a modification of the original St. Jude valve by inclusion of a silver-coated sewing ring aiming at reducing prosthetic valve endocarditis (PVE), based on studies which documented the safety and efficacy of silver for antimicrobial protection. But a significant incidence of early major paravalvular leak (PVL) events obliged withdrawal of the valve from the market.

In a paper published in this issue of the . . . [Full Text of this Article]