A Clinical Study of Tissue Valve Failure

Kang, Duk Hyun; Chai, Ihn Ho; Cho, Myoung Chan; Kim, Young Kwon; Kim, Duk Kyung; Sohn, Dae Won; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo

Abstract

On reoperations for tissue valve failure from December 1981 to December 1989, we had diagnosed 71 cases as primary tissue failure. In those cases we found out risk factors of accelerated primary tissue failure and increased thrombogenecity. We reviewed also long-term follow-ups of 542 patients after tissue valve replacement from 1978 to 1982, and durability of tissue valve was evaluated with the freedom rate from primary tissue failure. The results were as follows. 1) Eight patients had undergone reoperation by Dec. 1989 ; 71 cases(80.7%) for primary tissue failure, 11 cases(12.5%) for prosthetic valve endocarditis, 4 cases(4.5%) for thromboembolism, and 2 cases(2.3%) for paravalvular leakage. primary tissue failure was the main cause(80.7%) of tissue valve failure. 2) Primary tissue failure occurred at a mean postoperative interval of 89.7 months(range : 19.9-143.2 months). 3)In children under the age of 18, mean implantation time was 62 months, and in adults mean implantation time was 96 months. In the child group primary tissue failure occurred earlier than in the adult group by 34 months(p<0.01) 4) Actuarial freedom from primary tissue failure was 97.6%+/-0.6% at 5 years and 84.4%+/-2.2% at 10 years. 5) The types and locations of prosthetic tissue valves resulted in no significant difference in durability. 6) Primary tissue failure was mainly caused by calcification of the cusps(76%) 7) In atrial fibrillation the incidence of atrial thrombi was 31.3% and left atrial thrombi was the most common finding(60%) In conclusion, 1) Durability of tissue valve for 10 years is acceptable, but the limited durability of tissue may be a major concern after 10 years. 2) In children under the age of 18, tissue valve should be avoided due to accelerated tissue failure. 3) Atrial fibrillation clearly increases the risk of thromboembolism and anticoagulation is considered to be required in patients with atrial fibrillation.