The future of bioprosthetic valves.

The glutaraldehyde treated bioprosthetic heart valve is the most intensively studied valve in the history of heart valve replacement. The valve is examined from three aspects: hemodynamics, thromboembolism, and durability. The hemodynamic performance of the porcine bioprosthetic heart valve reveals that it performs as well as the Hall-Medtronic valve, better than the Starr-Edwards valve, but not as well as the St. Jude valve. The main reason for using the bioprosthetic heart valve is to decrease thromboembolism or avoid anticoagulation. The author concludes that evidence appears to support that with bioprosthetic heart valves the incidence of thromboembolism is indistinguishable from the best mechanical heart valves, with the difference being that patients with bioprosthetic valves do not need to be anticoagulated. In our experience with durability at 15 years, freedom from primary tissue failure with the porcine bioprosthetic heart valve is 41% for all valves, 44.8% for the aortic valves, and 40.8% for the mitral valve. After 15 years experience with the porcine bioprosthetic heart valve its main limitation is its lack of durability and therefore currently is used for selected indications.