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Prosthetic Valves, Transcatheter Valves and Valve Repairs

  • Annette Vegas
Chapter

Abstract

  • Prosthetic valves can be grouped into 2 broad categories: mechanical (bileaflet, tilting disc, caged ball) or bioprosthetic/tissue (stented, unstented, homografts).

  • Percutaneous valves are inserted using a transcatheter system. These valves have a metal frame onto which bovine or porcine pericardium is attached creating 3 leaflets. The valves can be deployed into native valves and prosthetic valves as valve in valve procedures.

  • The choice of prosthesis balances the (1) need for anticoagulation, (2) durability, and (3) valve function.

  • Despite improving patient survival and quality of life, prosthetic valve implantation is palliative, not curative, as all prosthetic valves have inherent problems. Prosthetic valvular dysfunction may result from structural failure, endocarditis, thrombosis, pannus formation, or technical issues during implantation.

  • Surgical implantation involves selecting the correct (1) prosthesis size and height, (2) valve orientation, and (3) insertion level (valvular or supravalvular). Interrupted sutures are used to secure the valve sewing ring to surrounding tissue.

  • Intraoperative TEE during prosthetic valve surgery, a SCA/AHA class I indication, determines baseline prosthetic valve function, detects any issues which require immediate reintervention, and monitors cardiac function.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Annette Vegas
    • 1
  1. 1.Professor of Anesthesiology, Former Director of Perioperative TEE, Department of AnesthesiaToronto General Hospital, University of TorontoTorontoCanada

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