Outlet strut fracture of Björk-Shiley convexo concave heart valves: the UK cohort study

Abstract

OBJECTIVETo investigate the risk of outlet strut fracture (OSF) in Björk-Shiley convexo concave (BSCC) valves in relation to patients' clinical and valve characteristics.DESIGNA cohort of 2977 patients with 3325 valves with a follow up of 18 years.SETTING38 cardiac implantation centres in the UK.RESULTS56 OSF events were reported with 43 occurring in mitral and 13 in aortic valves. The overall OSF rate was 0.17%/year. No dominant clinical factor of risk was found, but multiple regression analysis identified age, body surface area, valve size, shop order fracture rate, and manufacturing period as risk factors for OSF. A 4% (95% confidence interval (CI) 2% to 6%) decrease in the risk of OSF was observed for each advancing year of age and a fivefold (95% CI 2 to 13) increase in risk for a 0.5 m2 increase in body surface area. The association between the risk of OSF and valve size was not constant over time. Excess risks among 31 mm and 33 mm sizes (mainly mitral valves) decreased over time while that for 23 mm (almost all aortic valves) increased. The risk of OSF increased by 40% (95% CI 20% to 50%) for a unit increase in the fracture rate of other valves in the same batch. For valves manufactured during 1981 to 1984 the risk of OSF was 4 (95% CI 2 to 12) times greater than for valves manufactured before 1981.CONCLUSIONSThe OSF rates for 60° BSCC valves observed in the UK are the highest among all monitored populations. The changing patterns of mitral and aortic valve OSF rates over time observed in this study have not been identified previously and highlight the need for continued monitoring of patients with the BSCC valve.

Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery

“…Interestingly, failures of mechanical valves in the past have always been related to high forces generated by the nonphysiologic closing mode. These include fracture of the outlet strut (Bjork-Shiley) by closing rebounds (30,31), leaflet erosion (Duromedic) by cavitation (32), thrombosis (Medtronic Parallel) (33,34) and closing leaflet dysfunction (Medtronic Advantage) as well as by design flaws (35). The forces observed during a mechanical bi-leaflet valve's closure are by far higher than those needed to close a tissue valve.…”