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European Journal of Cardio-Thoracic Surgery, Vol 11, 703-708, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Non-destructive assessment of 62 Dutch Bjork-Shiley convexo-concave heart valves

BA de Mol, PJ Overkamp, GL van Gaalen and AE Becker
Department of Cardiopulmonary Surgery, Academic Medical Center, University of Amsterdan (Academisch Ziekenhuis bij de Universiteit van Amsterdam, The Netherlands.

OBJECTIVE: Non-destructive assessment of 62 Bjork-Shiley convexo- concave heart valves in view of the risk of fracture and possible detection of defects by means of X-ray or acoustics. METHODS: Scanning electron microscopy and stereomicroscopy of an unselected sample of valves, representing approximately 70% of the valves explanted between 1991 and 1996. Mean duration of implantation was 10.7 +/- 1.9 years. RESULTS: Six of the 62 valves had a fracture with disk escape. Of the remaining 56 valves, 11 (19.6%) had a single-leg fracture and seven (12.5%) showed a crack. Valves, 24 (42.8%), revealed no significant defect. After 4600 days of implantation, large valves (i.e. > or = 29 mm) showed a 6.7 time increase in the risk of crack or single-leg fracture compared with smaller valves (OR 6.7, 95% CI 1.8-24.6, P = 0.04). In a small in-vitro experiment with single-leg fracture, rapid smearing occurred, resulting in strut leg separation upon some movement. CONCLUSIONS: After approximately 400 x 10(6) cycles, 42.5% of the retrieved intact valves was without significant defect, while 32% had a serious prefracture defect. Time evolution from defect to fracture remains unpredictable. Also, detection of prefracture defects, including single-leg fracture, remains difficult, because a "well- detectable' fracture with dislocation is just a brief condition. However, technical knowledge can enhance the epidemiological and manufacturing information used for clinical decision making.

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