Bjork-Shiley Tilting Disc Valve Research Articles

A Bjork-Shiley Valve 40 Years in Action

The Bjork–Shiley mechanical heart valve (Shiley Corp, Irvine, CA) was one of the earliest tilting disc valve prosthesis used for the replacement of diseased cardiac valves. This valve was implanted in a large number of patients in the 1970s and early 1980s. A change in the valve design in the early 1980s led to a high rate of fracture and disc escape and a high patient mortality. As a result, the manufacturer of this valve stopped the production of the valve. We recently treated a patient with a Bjork–Shiley mitral valve prosthesis implanted more than 40 years ago. An 83-year-old man with cardiomyopathy, permanent atrial fibrillation, and a biventricular pacemaker with threatened skin erosion of the pacemaker pocket underwent revision of the pacemaker pocket with transfer of the pacemaker generator to a sub-pectoral position. He had undergone a mitral valve replacement with a Bjork– Shiley tilting disc valve in 1970 (Fig 1). In preparation for surgery, an intravenous heparin infusion was started and warfarin was withheld until international normalized ratio level reached 2. The Bjork–Shiley tilting disc valve was a low profile mechanical valve with a Delrin disc held in a tantalum housing by two metal struts. The valve was introduced in clinical practice in 1969 [1]. The initial Delrin disc was subsequently replaced with a pyrolytic carbon disc. This valve provided significant advantage over the bulky Starr–Edwards cage ball valve with a lower transvalvular gradient [2]. A change in the design of the valve led to a high failure rate of this valve and its disappearance from

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Problems associated with mechanical heart valve sounds.

A cross-sectional study of 50 randomly selected patients 12-36 months following mechanical heart valve replacement with Bjork-Shiley tilting disc valves was undertaken to investigate the factors which affect perception of, and reaction to, sounds generated by mechanical heart valves implanted in patients. Numerous problems were generated by the valves, including annoyance (68%), sleep disturbance (52% in patients; and 46% in patients' partners), interference with concentration (36%) and social embarrassment (28%). These findings are not affected by the measured level of sound or any variation in the number or anatomical position of the valve(s), though age and sex do seem to matter, more problems being reported by younger patients and those of the female sex. Aspects of the patient's personality did not seem to alter the difficulties experienced, though a high level of psychological morbidity was identified in the group as a whole. Most patients experience problems due directly to the noise generated by their valve and should be adequately warned of this before operation. This should also be taken into consideration in designing and evaluating new valve prostheses.

An emergency physician's guide to prosthetic heart valves: identification and hemodynamic function.

We describe methods for identifying the type and size of seven commonly used prosthetic heart valves and how these features influence the hemodynamics of flow through the valve. The four mechanical heart valves reviewed are Starr-Edwards silicone rubber ball valves (Models 1200/1260 aortic and 6120 mitral valves), Bjork-Shiley tilting disc valves (60 degrees standard spherical model and the 60 degrees convexo-concave model), Medtronic-Hall (Hall-Kaster) tilting disc valve, and St Jude Medical bileaflet valve. The three bioprostheses reviewed are Hancock porcine valve, Carpentier-Edwards porcine valve, and Ionescu-Shiley bovine pericardial valve. These valves were chosen because of their past or present popularity and therefore are the ones most apt to be implanted in patients seen in the emergency department.

169 Five years experience with thrombolytic treatment of late thrombosis of the tricuspid Bjork-Shiley tilting disc valve

169 Five years experience with thrombolytic treatment of late thrombosis of the tricuspid Bjork-Shiley tilting disc valve

In vitro pulsatile flow velocity and shear stress measurements in the vicinity of mechanical mitral heart valve prostheses

A three beam laser Doppler anemometer system was used to study the flow fields created by various types of mitral heart valve prostheses under physiological pulsatile flow conditions. The prosthetic valves studied were: Beall caged disc valve, Bjork-Shiley tilting disc valve, Medtronic-Hall tilting disc valve and St. Jude bileaflet valve. The results indicate that all four prosthetic valve designs studied create very disturbed flow fields with elevated turbulent shear stresses and regions of flow separation and/or stagnation. The observed elevated turbulent shear stresses could cause sublethal and/or lethal damage to red cells and platelets. The regions of flow separation and/or stagnation, could lead to thrombus formation and/or tissue overgrowth on the valve structure, as observed on clinically recovered prosthetic valves.

Can a mechanical heart valve be used in the tricuspid position? experience with the Björk-Shiley tilting disc valve in 70 patients.

Experience of the Bjork-Shiley tilting disc valve as replacement for irreparably diseased tricuspid valves in 70 consecutive patients is reported. There were 11 isolated tricuspid valve replacements and 59 in combination with other valve replacements. Only 1/17 early deaths was attributable to the tricuspid prosthesis per se and 1/3 late deaths was probably an anticoagulant complication. The main problem was late thrombotic malfunction of the tricuspid prosthesis in four patients on eight occasions (3.2% year−1). Ebstein's anomaly and deficient anticoagulation were probable aetiological factors, although the complication remained unexplained in three instances. Relief by means of thrombolytic treatment(4) and re-replacement(4) involved neither disabling complications nor mortality. Normal function of the tricuspid prosthesis was observed in 49/53 patients over an average period of 4.9 years (range 0.2–9 years). There were no instances of tricuspid prosthetic endocarditis, paraprosthetic leakage or other serious complications. We consider the Bjork-Shiley prosthesis a suitable replacement for most cases of irreparable tricuspid valvular disease, provided that anticoagulation can be managed effectively. The only questionable indication is Ebstein's anomaly, which constitutes a high risk of thrombotic malfunction of the tricuspid prosthesis.

Management of dissecting aneurysms of the aorta.

During the last 20-year-period 42 patients with dissecting aortic aneurysms were treated at this hospital. The ascending aorta was involved in 23 patients, while 19 aneurysms were localized to the descending aorta. Ascending aneurysms were operated upon with an early mortality rate of 35%. A re-entry procedure via an abdominal incision was performed in one patient. Graft replacement and aortic valve replacement with the Bjork–Shiley tilting disc valve were performed in 8 patients and in 3 of the patients re-implantations of the coronary arteries were also performed. Six patients underwent graft replacement with resuspension of the aortic commissures. Graft replacement only was performed in 2 patients. Eight operated patients are still alive after a mean follow-up period of more than 4 years. Four of six patients, who were not operated upon, died early and only one patient in the non-treated group is still alive (follow-up period 1 year). Nine of 19 patients with descending aneurysms were operated upon and...

Thirteen year-experience with mitral valve replacement.

At the Niigata University Hospital, various kinds of prosthetic valves such as the Starr-Edwards noncloth- and cloth-covered, Bjork-Shiley tilting disc, and Carpentier-Edwards porcine valves, have been used from September, 1965 to March, 1979 for replacement of diseased valves on 176 patients.The patients with Starr-Edwards noncloth- and cloth-covered ball valves showed survival rates of 90 and 84% over a period of 5 years, and 87 and 81% for 8 years. Those with Carpentier-Edwards porcine and Bjork-Shiley tilting disc valves exhibited a survival rate of 93% for 1 and 3 years respectively.Since 1973, regarding postoperative thromboembolic complications, patients who could not be maintained within a suitable therapeutic range using Warfarin, were given Bucolome also. For the patients with the Starr-Edwards cloth-covered valve, the 6-year major thromboembolism-free rate was 92% in those operated before 1973 and 96% for those operated since 1973. The minor episodes were free in 85 and 100%, respectively.The actuarial reoperation rate at 7 years was 7% for the patients with Starr-Edwards noncloth-covered and 1% for those with cloth-covered valves. However, there was only one death among 7 patients. No reoperation was carried out for the other valves.In conclusion, the actuarial survival curve for the Starr-Edwards ball valves showed a good survival rate when the patients age at the operation was taken into account. The use of the Bjork-Shiley tilting disc and Carpentier-Edwards porcine valves is also justified within the constraint of the short follow-up period.

Ten years' experience of surgical management of triple valve disease. Early and late results in thirty-four consecutive cases.

Ten years' surgical experience in 34 consecutive patients with triple valve disease is reviewed. All patients but two (94%) were in functional class III or IV (N.Y.H.A.) before surgery. Nineteen patients underwent triple valve replacement and 15 combined aortic and mitral valve replacement and tricuspid annuloplasty. The Bjork–Shiley tilting disc valve prosthesis was employed for all valve replacements.The early mortality was 21% (4/19) for triple valve replacement and 20% (3/15) for combined aortic and mitral valve replacement and tricuspid annuloplasty. The risk factors which affected the operative mortality were functional class IV, age over 60 years, and radiological heart volume above 900 ml/m2 BSA. There were two late deaths, 45 and 48 months, respectively, after operation. One was caused by arrhythmia. The other was due to thrombotic encapsulation of the mitral valve prosthesis (0.8%/year). The overall 5-year survival rate, including early mortality, was 75% (15/20).Subjective improvement was noted...

Combined mitral and aortic valve replacement with the Börk-Shiley prosthesis.

Combined mitral and aortic valve replacement with the BJORK-Shiley tilting-disc valve prosthesis was performed in 42 patients. Hospital and late mortality rates were both at the 9.5% level. No correlation was seen between mortality and combination of concomitant valve lesions. Morbidity was elevated. No episodes of embolism were observed after surgery, although one patient died of severe haemorrhage. Only one patient showed valvular dysfunction (grade 2/4 leakage), but did not require reoperation. Postoperatively, 75.7% of the patients were asymptomatic for a mean follow-up period of 21.1 months. The Björk-Shiley prosthesis offers a small gradient associated with a low profile, which constitute important advantages in multiple valve replacement.

Haemolysis in Ball Valves With Overlapping and Non-Overlapping Closing Mechanisms:An Experimental Study

Overlapping and non-overlapping closing mechanisms of the ball valve type were evaluated in regard to rates of haemolysis. the test chamber used in this experimental study permitted an almost physiological valve function in a minimal volume of human whole blood. An overlapping closing mechanism was represented by the Starr-Edwards aortic silastic ball valve and a non-overlapping one by the Smeloff-Cutter aortic silastic ball valve.Red cell destruction was significantly lower with a non-overlapping ball than with an overlapping one on valve closure. the magnitude of red cells destroyed in 80 ml of blood/hour was, on average, 0.29 % and 0.73 % respectively. the Bjork-Shiley tilting disc valve was tested as a control and accounted for a red cell destruction of 0.20%.Assuming a linear progression of haemolysis with time, a blood volume of 4 800 ml, and a normal erythrocyte survival time of 120 days, the red cell destruction attributable to the prosthetic closing mechanisms could be extrapolated to in uiuo con...

Haematological evaluation of the Björk-Shiley tilting disc valve prosthesis in isolated aortic valvular disease.

All the 147 long-term surviving patients, following 161 consecutive operations of isolated aortic valvular lesions with the Bjork-Shiley tilting disc valve, were investigated haematologically before, and 7 months after surgery. Seventy of these patients were re-examined 28 months after operation. The present material showed no signs of anaemia after operation and serum iron remained at normal levels, although no iron was administered during the entire follow-up period. The degree of haemolysis, evaluated by the serum lactic de-hydrogenase activity (LDH), increased significantly with the angiographical degree of paravalvular regurgitation. Even slight and haemodynamically insignificant paraprosthetic leaks were associated with an increased haemolysis, probably due to a regurgitant jet causing turbulence during diastole. Turbulence, acting as an extra prosthetic factor, is considered a determinant of haemolysis after aortic valve replacement with the Bjork-Shiley valve. The degree of haemolysis was related ...

Regurgitation and Haemolysis in Artificial Heart Valves: An Experimental Study of Overlapping and Non-overlapping Closing Mechanisms and of Paraprosthetic Leakage

Overlapping and non-overlapping prosthetic closing mechanisms were evaluated in respect of regurgitation and haemolysis. The test chamber, which is described in this paper, permitted an almost physiological valve function in a minimal volume of human whole blood. A non-overlapping closing mechanism was represented by the Bjork-Shiley tilting disc valve and an overlapping one by the Lillehei-Kaster pivoting disc prosthesis.Regurgitation after closure of the Bjork-Shiley prosthesis, when the non-overlapping disc was seated, increased linearly with the mean diastolic pressure difference. The slope of this line increased with the size of the tissue diameter of the prosthesis and was steepest for valve size 29 mm. Converted to in vivo conditions, this regurgitation corresponded to 2% of an average forward stroke volume of 80 ml at rest in patients with 21 or 23 mm valves. With 25, 27 and 29 mm valves, the corresponding values were 3%, 3% and 5%, respectively. Regurgitation would diminish with the haemodynamic ...

Aortic valve replacement in patients over the age of sixty.

Twenty-nine consecutive patients over the age of 60 with isolated aortic valvular disease, who had undergone aortic valve replacement with the Bjork-Shiley tilting disc valve prosthesis, were subjected to a clinical, angiographic and haemodynamic follow-up study. Before surgery, this material was characterized by long histories of deterioration, pre-dominance of male patients and patients with aortic stenosis, marked cardiac enlargement and by impaired functional capacity, working capacity and pump function of the left ventricle. Congestive heart failure and pulmonary hypertension were uncommon in these elderly patients, who were incapacitated by marked obstruction and/or severe regurgi-tation.The main effect of aortic valve replacement was a shift of the central circulation to a more normokinetic type, an increase in stroke volume and a decrease in the filling pressure of the left ventricle. In patients with aortic stenosis, the systolic pressure of the left ventricle was normalized and stroke work marke...

Mortality and pathology following aortic valve replacement with the Björk-Shiley tilting disc valve.

The cause of death and the main pathology in 20 patients following 161 aortic valve replacements with the Bjork-Shiley tilting disc valve were evaluated by classical pathological methods. Hospital mortality was 5% (8 patients), while 7% (12 patients) died later. Myocardial failure (9 patients) was the predominant cause of death. The remainder died of cerebral haemorrhage (3 patients), malignancy (3), infection (2), dissecting aortic aneurysm (1), hepato-renal syndrome (1) and thromboembolism in the absence of anticoagulant treatment (1). Gross cardiomegaly was found in all the 20 hearts examined. The low rate of prosthetic problems is ascribed to the design of the Bjork-Shiley tilting disc valve with its excellent wear characteristics and long durability. The absence of intimal changes in the area of the coronary ostia is also attributed to its construction with a low gradient, laminar flow and minimal turbulence. With anticoagulant treatment in long-term survivors with the Bjork-Shiley valve in the aorti...

Aortographic follow-up in patients with the Björk-Shiley aortic disc valve prosthesis.

One hundred aortographic examinations were performed in a follow-up study of 99 long-term survivors after aortic valve replacement with the Bjork-Shiley tilting disc valve. Regurgitation of the contrast medium through the prosthesis as well as paravalvular leakage were evaluated. The regurgitation was minimal (grade I) in 57%, moderate (grade II) in 38%, marked (grade III) in 3% and very marked (grade IV) in 2%. The grade IV cases were re-operated on with closure of paravalvular leakage. The minimal or “functional” regurgitation through the valve prosthesis is an expected finding. It is due to the construction of the Bjork-Shiley valve, whereby the disc fits within its orifice leaving a minimal space between the edge of the disc and the ring. The follow-up aortography showed aneurysms in five patients, deformations of the ascending aorta in three and an iatrogenic ventricular septal defect in one patient.

Encapsulation of the Björk-Shiley aortic disc valve prosthesis caused by the lack of anticoagulant treatment.

We have never experienced encapsulation or massive thrombosis of a Bjork-Shiley aortic valve prosthesis in a patient receiving an adequate anticoagulation treatment. An encapsulation has, however, been described after many different types of heart valve replacements. Early diagnosis and emergency operation are mandatory. We have only encountered two cases of massive thrombosis in Bjork-Shiley tilting disc valve prostheses in the aortic position out of 300 implants. Anticoagulant treatment was not given in either case. One patient died before final diagnosis was made and the other underwent an emergency operation. It was possible to clean out all thrombus material on both sides of the valve after temporary removal of ths disc and rotation of the valve. This method cannot, however, be recommended for general use. If the surgeons are not experienced in the proper removal of the disc, they will bend the struts so that the disc will not function properly after re-insertion. The insertion of a new prosthesis is...

The Björk-Shiley tilting disc valve in isolated mitral lesions.

During the period September 1969 to August 1971, 103 consecutive patients underwent mitral valve replacement with the Bjork-Shiley tilting disc valve prosthesis. Forty-four of these patients had isolated mitral lesions. They were studied pre- and postoperatively in a long-term clinical and haemodynamic follow-up. The valve, which had a Delrin disc occluder and opened at an angle of 50°, was placed in a subannular position with isolated mattress sutures and with the larger opening directed towards the ventricular septum. Early and late mortality rates were 5 and 16%, respectively. Thrombo-embolic complications occured in 25% of the cases, half of which were without sequelae. All patients received anticoagulant treatment (Dicoumarol). Thirty-six patients were evaluated at this Clinic 6-12 months postoperatively and 30 of them were catheterized. Subjective improvement was seen in 34/36 and functional improvement (NYHA) in 30/36 patients. Careful haemodynamic evaluation revealed central circulatory improvment...

Evaluation of the 21 mm Björk-Shiley tilting disc valve in patients with narrow aortic roots. A clinical, haemodynamic and angiographic study.

Nineteen out of 23 consecutive patients with aortic valvular lesions and narrow aortic roots, operated upon with the 21 mm Bjork-Shiley tilting disc valve prosthesis, were subjected to a clinical and haemodynamic pre- and postoperative study. An angiographic examination was carried out after valve replacement.The total mortality was 1/23 patients (4%). Clinical improvement was found in 17/19 patients (89%) after surgery. No thrombo-embolic episodes occurred during the follow-up period.The main response to aortic valve replacement was an obvious reduction of the pressure load of the left ventricle as indicated by the marked decreases in left ventricular systolic pressure and stroke work. These changes were most pronounced at rest and accompanied by reduction of distressing symptoms, increase in working capacity and decrease in cardiac enlargement. Unloading of the left ventricle after aortic valve replacement did not influence heart rate, heart rhythm, stroke volume and kinetics of the central circulation ...