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(Circulation. 2005;111:2850-2857.)
© 2005 American Heart Association, Inc.

Special Report

Twenty-Five–Year Experience With the Björk-Shiley Convexoconcave Heart Valve

A Continuing Clinical Concern

William J. Blot, PhD; Michel A. Ibrahim, MD; Tom D. Ivey, MD; Donald E. Acheson, MD; Ron Brookmeyer, PhD; Arthur Weyman, MD; Joseph Defauw, MD; J. Kermit Smith; Donald Harrison, MD

From the International Epidemiology Institute (W.J.B.), Rockville, Md; Johns Hopkins University (M.A.I., R.B.), Baltimore, Md; the Cardiac Surgery Institute (T.D.I.), Cincinnati, Ohio; London, England (D.E.A.); Massachusetts General Hospital (A.W.), Boston, Mass; Saint Antonius Hospital (J.D.), Nieuwegein, the Netherlands; Trustees Bowling-Pfizer Settlement Funds (J.K.S.), Cincinnati, Ohio; and the University of Cincinnati (D.H.), Cincinnati, Ohio.

Correspondence to William J. Blot, PhD, 1455 Research Blvd, Suite 550, Rockville, MD 20850. E-mail blotw{at}iei.ws

Received October 5, 2004; revision received January 4, 2005; accepted January 31, 2005.

Background— The first Björk-Shiley convexoconcave (BSCC) prosthetic heart valves were implanted in 1978. The 25th anniversary provided a stimulus to summarize the research data relevant to BSCC valve fracture, patient management, and current clinical options.

Methods and Results— Published and unpublished data on the risks of BSCC valve fracture and replacement were compiled, and strategies for identifying candidates for prophylactic valve reoperation were summarized. By December 2003, outlet strut fractures (OSFs), often with fatal outcomes, had been reported in 633 BSCC valves (0.7% of 86 000 valves implanted). Fractures still continue to occur, but average rates of OSFs in 60° valves are now <0.1% per year. OSF risk varies markedly by valve characteristics, especially valve angle and size, with weaker effects associated with other manufacturing variables. OSF risks are mildly lower among women than men but decline sharply with advancing age. The risks of valve replacement typically greatly exceed those of OSF. By comparing individualized estimated risks of OSF versus valve replacement, guidelines have been developed to identify the small percentage of BSCC patients (mostly younger men) who would be expected to have a gain in life expectancy should reoperative surgery be performed.

Conclusions— Twenty-five years after the initial BSCC valve implants, fractures continue to occur. Continued monitoring of BSCC patients is needed to track and quantify risks and enable periodic updating of guidelines for patients and their physicians.

Key Words: valves • prosthesis • risk factors • epidemiology • surgery

Related Article:

Could It Happen Again?: The Björk-Shiley Convexo-Concave Heart Valve Story

Eugene H. Blackstone
Circulation 2005 111: 2717-2719. [Full Text]

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