J Thorac Cardiovasc Surg 2006;132:443-444
© 2006 The American Association for Thoracic Surgery
What patients want: A new biological era in valvular prostheses
Paolo Biglioli, Prof MD,
Fabio Barili, MD,
Gianluca Polvani, Prof MD
Department of Cardiovascular Surgery, Centro Cardiologico Monzino, University of Milan, Milan, Italy
To the Editor:
We read with great interest the article by Smedira and associates.
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It deals with the important issue of valvular disease and gives further data to help surgeons to choose the right prosthesis.
One of the points that attracted our attention was the aim of the study. As the authors clearly expressed, the renewed interest in biologic prostheses reflects increased attention given by patients to the biologic valve.
We are experiencing a similar trend. An increasing number of patients are well informed about the benefits and risks of all types of prostheses when they are admitted to the hospital for valve replacement. Contrary to guidelines, a growing number of patients prefer to choose a biologic prosthesis, even if they are young and will require a prosthesis replacement. The reasons for this trend vary. First, a patient who must undergo valve replacement is interested not only in life expectancy but also in quality of life. Anticoagulant therapy is considered a major limitation to quality of life, especially in those young patients who have an active lifestyle and do not want to change their habits. Moreover, they are more concerned by the risk of thromboembolism linked to mechanical prostheses and to anticoagulation than by reoperation. Patients actually know that mortality and morbidity risks after reoperation are decreasing.
Another important topic that is leading more patients to choose a biologic prosthesis is the strong belief in technology and technologic advances. Starting with the consideration that the mean life expectancy of biologic prostheses is calculated on valves implanted 15 to 20 years ago, newer prostheses probably will last longer because they are constructed with new techniques and treated with new anticalcification treatments. Moreover, those patients strongly believe that future replacement prostheses probably will have an even longer life expectancy.
The surgeon must take note of this new trend. In our institute we are implanting an increased number of biologic prostheses even in younger patients. Even the number of Bentall operations performed with biologic valves is increasing, as is the number of valve repairs. Moreover, we have started a research program with the aim of constructing recellularized homografts so that we can offer new alternatives to mechanical prostheses, as other institutes are doing.
The role of the patient is a determining factor in the choice of the prosthesis today. Patients are well informed and their choice is opening a new era in the field of biologic prostheses.
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References
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- Smedira NG, Blackstone EH, Roselli EE, Laffey CC, Cosgrove DM. Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients?. comparison of explantation for structural valve deterioration of allograft and pericardial prostheses. J Thorac Cardiovasc Surg
2006;131:558-564.
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