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The Annals of Thoracic Surgery, Vol 47, 436-440, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Bjork-Shiley strut fracture and disc escape: literature review and a method of disc retrieval

PN Hendel
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.

Embolization of a prosthetic valve poppet is a rare but life- threatening event. It was reported sporadically before the introduction of the Bjork-Shiley 70-degree convexoconcave prosthesis in 1980. Since that time, there have been a large number of reported mechanical failures with disc escape. The rate for the 29-mm to 33-mm mitral valves is estimated as 5.2%. In 29 of 35 patients (including the 2 presented here) in whom the site of disc lodgment could be determined, the disc was in the descending or abdominal aorta. Fifteen of these patients died. Six survivors had the disc removed at the same operation and 6 at a later operation. In 2 patients, the disc was not removed. In 2 patients in whom the disc was not removed initially, it was thought to contribute to postoperative complications. Two more cases of structural failure of the Bjork-Shiley convexoconcave prosthesis are presented. A transpericardial approach to the descending aorta on bypass is described. It allows easy removal of the disc and eliminates the need for a second operation.