The advantages and disadvantages of prosthetic valves for aortic valve replacement

Abstract

The ideal substitute for the diseased aortic valve has yet to be discovered. At the moment the most significant choice involves the Starr-Edwards prosthesis and the homograft aortic valve, each with its own deficiencies. Aortic insufficiency has followed a number of homograft insertions; the threat of cusp degeneration and calcification remains as a further deterrent to wide-spread adoption of homografts. Thromboembolism and, more recently, ball variance in Starr-Edwards valves detract from the benefits of such technical assets as ease of insertion and dependable valvular competence. The cloth-covered aortic prosthesis has been designed, but has not yet been proved, to overcome these deficiencies. An accurate statistical appraisal of clinical results has shown that either valve inserted in the patient with aortic valve disease will provide a comparable chance for a good result for the first 2 postoperative years. No further data are available for the homograft (from this institution) at this time, but actuarial curves for the Starr-Edwards prosthesis demonstrate a persistent good result for an additional 2 years. A similar lack of deterioration for homograft aortic valves can be ascertained only by the results of future analysis.