AV VALVE REPLACEMENT: WHAT'S THE PROBLEM?

摘要

Mitral valve replacement was first described in a clinical canine patient by Eyster in 1976. Since that time, several other case reports and a small number of case series of atrioventricular valve replacement, in clinical patients, have been published. Valve types have varied from the original mechanical Starr-Edwards (ball) mitral valve to bileaflet (St Judes) mechanical valve and to bioprosthetic valves of either glutaraldehyde-treated porcine aortic valves or bovine pericardium (Carpentier-Edwards). Atrioventricular valve replacement is an attractive therapy because, in theory, the "new" valve should be immediately and completely "competent". Atrioventricular valve replacement has been described predominantly in the mitral position although tricuspid valve replacement was the subject of one case series. Most of the reports describe relatively short term outcomes but almost all of the reports have concluded that valve replacement was either a good solution (for an individual animal) or worthy offurther evaluation or study. Collectively, the profession is very early in its experience with atrioventricular valve replacement and almost all descriptions of this therapy to date, recommend additional adjustments to the case management protocols thatwould, in theory, improve the outcome for our patients. Why, then, has atrioventricular valve replacement not become a more accepted and more readily available therapy for dogs with atrioventricular valve disease?