1. PROTESI VALVOLARI CARDIACHE:
INDICAZIONI E DATI EPIDEMIOLOGICI IN ITALIA
Prof. Carlo Antona
Direttore Dipartimento
Cardio-Cerebro-Vascolare
U.O.Cardiochirurgia
ASST Fatebenefratelli-Sacco
Università degli Studi di Milano

2. VALVE REPAIR/REPLACEMENT: HOSPITALIZATION TREND

3. VALVE REPAIR/REPLACEMENT:
30-DAY MORTALITY

4. CARDIAC PROSTHETIC VALVES
Mechanical valves:
Single tilting disc
Bileaflet
Biological valves:
Homografts
Pulmonary autografts
Porcine
Pericardial bovine
Pericardial equine
Biological valves:
Sutureless/
Rapid deployment
TAVI
Xenograft:
Stented
Stentless

5. MECHANICAL PROSTHESES
Starr-Edwards
Medtronic-Hall
SJM Regent

6. STENTED BIOPROSTHESES
Pericardial
Porcine
Carpentier-Edwards
Medtronic
SJM

7. STENTLESS BIOPROSTHESES
Medtronic Freestyle

8. SUTURELESS BIOPROSTHESES
ATS 3f Enable Medtronic
Perceval S Sorin - Livanova
Intuity Elite Edwards

9. TAVI Edwards Centera Medtronic Engager Boston Scientific Lotus
CoreValve
Evolut R
Edwards
Sapien XT
Direct Flow Medical
JenaValve
St Jude Portico
Symetis

10. CARDIAC PROSTHETIC VALVES: PROS & CONS
ANTICOAGULANT-RELATED BLEEDING
+ THROMBOEMBOLISM
(INR, concomitant ASA/dual antiplatelet therapy,
patient’s risk factors)
Mechanical
valves
Biological
valves
STRUCTURAL VALVE DETERIORATION
(mitral > aortic prosthesis,
risk of reoperation slightly higher than first operation)

11. THE PROSTHESIS CHOICE….
SOME ISSUES ABOUT
THE PROSTHESIS CHOICE….
Valve-related event-free survival
Structural valve deterioration
(11 years in 20-year-old patients, 25 years in 65-year-old patients)
Anticoagulation treatment duration (valve repair versus mechanical)
Thrombosis/thromboembolism
Bleeding
Pregnancy
Infections

13. VS

21. CONCLUSIONS - I
In the last years, we assisted to a progressive increase
in the use of biological valves compared to mechanical ones
TAVI procedures continue growing up among
old inoperable patients; moreover, there is a trend towards
increase also in intermediate-risk cathegory
80% of aortic valve replacement is performed
with biological prostheses

22. CONCLUSIONS - II
Mitral valve repair represents about 50% of mitral procedures
Mitral valve replacement is performed in 60% of cases with
tissue valves and in 40% with mechanical prostheses
Prosthesis choise also depends on:
knowledge of anticoagulant therapy caracteristics
word of mouth
new possibilities with TAVI prostheses (V in V)
THANK-YOU