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Ann Thorac Surg 1992;54:117-122
© 1992 The Society of Thoracic Surgeons

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Articles

Ionescu-Shiley valve failure II: Experience with 25 low-profile expiants

^a Departments of Pathology and Surgery, University of Ottawa, Ottawa, Canada
^b University of Ottawa Heart Institute and Clinical Epidemiology Unit at the Ottawa Civic Hospital, Ottawa, Canada

Accepted for publication December 18, 1991.

^_* Address reprint requests to Dr Walley, Anatomical Pathology, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ont, K1Y 4E9 Canada.

A group of patients who had low-profile Ionescu-Shiley valves implanted, 237 aortic and 130 mitral, was reviewed for cases of bioprosthetic failure requiring explantation. Fourteen such aortic and 11 mitral valves were recovered at operation. The most common reason for explantation was valvular insufficiency due to cusp tears, accounting for 50.0% of aortic and 82.0% of mitral explants. Morphologic examination of the valves suggested a common mode of failure with tears, and this is illustrated. The clinical and pathologic patterns of this valve's failure are compared with those of the standard-profile Ionescu-Shiley valve, and many similarities exist. A tendency for a larger proportion of mitral valve failures with tears is, however, in contrast to observations of the standard-profile valve, in which aortic failures are more common. Additionally, low-profile valves, in either the aortic or mitral positions, fail after a shorter time in situ than their standard-profile counterparts, at a mean of 45.1 months versus 78.0 in the aortic position (p < 0.01) and at 52.2 months versus 73.8 in the mitral position (p < 0.05). These differences in the performance of the Ionescu-Shiley valve models may have implications for the design of future bioprostheses.

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