This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Collins, J. J. Search for Related Content PubMed PubMed Citation Articles by Collins, J. J. Related Collections Valvular heart disease CV surgery: valvular disease

(Circulation. 1999;99:2613.)
© 1999 American Heart Association, Inc.

Editorials

Risks of Valve Replacements in Young Women

John J. Collins, MD

From the Department of Surgery, Brigham and Women's Hospital, Boston, Mass.

Correspondence to John J. Collins, Jr, MD, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6195.

Key Words: Editorials • valves • women • pregnancy

Attempts to evaluate performance of cardiac valves by retrospective analysis are notoriously difficult because of the complexity associated with preoperative illnesses, types of replacement valves available or used, use of anticoagulant medications in some but not all patients, and a myriad of other differences. When a diverse group of women having multicultural backgrounds receive valves under various circumstances and at various intracardiac locations over an interval of 20 years, the difficulty of showing by rigorous statistical techniques that differences in individual outcomes are related to demonstrable or predictable circumstances relating to the valve is very great.

Nevertheless, Dr North and her associates¹ have carefully analyzed their data with 93% complete follow-up in 232 patients who received 323 valves between 1972 and 1992 and have presented the findings in as clear a manner as possible.

Principal conclusions include the observation that prosthetic valves had higher rates of thromboembolism; bioprosthetic valves were less durable; and homograft valves, suitable only for aortic valve replacement, were not useful for the much larger proportion of young women who required mitral valve replacement.

For young women who require heart valve replacement, the current need is for bioprosthetic valves that can be used in either the aortic or mitral position and that do not require warfarin-type or heparin anticoagulants.

For many patients, it has become possible to perform valvuloplasty, which allows preservation of the native mitral valve apparatus. The durability of mitral valve repair operations performed for degenerative disease seems adequate, with 90% freedom from reoperation reported . . . [Full Text of this Article]