Heart Valve Replacement and Future Trends in Cardiac Surgery

Nearly 100 000 heart valves were replaced last year. Almost 20% were in reoperations for prosthetic valve dysfunction. Roughly one half of bioprostheses (which constituted 30% to 40% of all valves implanted) will need to be replaced in 14 years. Despite this reduced durability, some physicians still prefer bioprostheses because the combined problem of thromboembolism and anticoagulant-related bleeding lessens the quality of life with mechanical valves. "Clearly patients with mechanical prosthetic heart valves need a new long-term anticoagulant or a means to self-regulate the dose of warfarin daily." Having said this, the authors do not mention Dupont's new portable device that uses finger-stick blood samples to measure prothrombin time and, analogous to blood glucose self-monitoring in the control of diabetes, may reduce the anticoagulation hazard through better self-control. At one time, bioprosthetics were considered to have a slower, more benign failure mode so that the reoperation could be done at