"Histoire de Valves"

Rémi NOTTINAFICCT, Tours, Vendredi 13 juin 2014

La chirurgie cardiaque à cœur fermé

Canal artériel 1938 Robert GROSS Boston Children Hospital

Coarctation 19441945

Clarence CRAFOORDRobert GROSS et HUFNAGEL

StockholmBoston

Tétralogie de Fallot 1944 BLALOCK-TAUSSIG BaltimoreJohn‘s Hopkins Hospital

Rétrécissement mitral 19251948

Henry SOUTTARCP BAILEY Philadelphie

La Commissurotomie Mitrale "à cœur fermé"

• Sir Henry Souttar : 1925, dilatation au doigt

• C.P. Bailey en 1948 effectue plusieurs

dilatations mitrales, qu’il nomme "commissurotomies". Il est suivi par Harken et Brock.

C.P. Bailey : 1948 Ch. Dubost :1953

Ecole BroussaisCharles Dubost

Ecole LaennecJean Mathé

Contre-indicationde la commissurotomie à cœur fermé

La Commissurotomie Mitrale "à cœur ouvert"(1956)

La Commissurotomie Mitrale "à cœur fermé" va devienir :

" La valvuloplastie Mitrale percutanée"

Rémi NOTTIN1983

La valvuloplastie Mitrale percutanéeavec le ballon d’Inoue (1990)

Inoue K; Clinical application of transvenous mitral commissurotomy, JTCS , 1984

LES PROTHESES VALVULAIRES MECANIQUESLES PROTHESES VALVULAIRES MECANIQUES

1965 199419801970 1985

Bjork Standart

Convexo-concave

Monostrut

Medtronic Hall Kaster

St Jude Medical

Carbomedics

Bjork-Shiley

Valvesà doublesailettes

STARRSTARR Smeloff CutterSmeloff Cutter

Valvesà disque

Sorin Bicarbon

ATS

Lowell EDWARDS

Valve de Hufnagel

1952 : 1ère valve artificielle

Valves de Starr Mitrales

The original Starr-Edwards mitral valve, implanted 1960. Lucite cage, Silastic rubber ball occluder.

Starr-Edwards Model 1260 introduced 1968. Teflon and polypropylene sewing ring, cast Stellite 21 cage. Still in use.

Starr-Edwards 2400 introduced 1972. Hollow Stellite ball, cloth covered Stellite cage. Discontinued 1980.

Starr-Edwards caged ball valves

Comparaison entre SMELOFF CUTTER et STARR EDWARDS

LES PROTHESES VALVULAIRES MECANIQUESLES PROTHESES VALVULAIRES MECANIQUES

1965 199419801970 1985

Bjork Standart

Convexo-concave

Monostrut

Medtronic Hall Kaster

St Jude Medical

Carbomedics

Bjork-Shiley

Valvesà doublesailettes

STARRSTARR Smeloff CutterSmeloff Cutter

Valvesà disque

Sorin Bicarbon

ATS

Björk-Shiley Tilting Disc Valves Donald P. Shiley, an engineer in Santa Ana, CA with a

garage Late 1960’s began developing heart valves Viking O. Björk, a Swedish heart surgeon came on board

a few years later

Radial-spherical (R/S) valve introduced in 1974. Subjected to several design changes. Flat occluder disc, originally of Delrin, later changed to pyrolytic carbon. Stellite housing. Opens to 50-60 degrees. Inlet and outlet struts are welded to the flange. Early failures of the inlet strut welds were eliminated with a change to the welding process.

Bjork Shiley avec disque en Delrin

Björk-Shiley Convexo-Concave valve: The Good News

C/C disc improves hemodynamics—decreased complications due to thromboembolism (TE)

Received FDA approval in 6 months Became the most popular valve in the

world (ultimately represented half of all valves implanted)

Bjork Shiley Convexo-concaveavec disque en carbone Pyrolitique

Björk-Shiley Convexo-Concave valve: The (Really) Bad News

First outlet strut fracture in 1978 during clinical trials

Valve Medtronic Hall (Hall Kaster)

Valve du Cardiowest

LES PROTHESES VALVULAIRES MECANIQUESLES PROTHESES VALVULAIRES MECANIQUES

1965 199419801970 1985

Bjork Standart

Convexo-concave

Monostrut

Medtronic Hall Kaster

St Jude Medical

Carbomedics

Bjork-Shiley

Valvesà doublesailettes

STARRSTARR Smeloff CutterSmeloff Cutter

Valvesà disque

Sorin Bicarbon

ATS

St Jude Medical1977

CARB

OM

EDIC

S CARBOM

EDICS

On-X’s Mitral valveATS = Medtronic Open Pivot

Autres valves à double ailettes

Quelques curiosités ….

Quelques curiosités ….

Harken Kay-Shiley

Quelques valves défaillantes

Beall Servelle

HOMOGREFFES : 1962 D. Ross et Barratt-Boyes

Bioprothèses porcinesavec stent

Carpentier- EdwardsStandard

1975

Carpentier- EdwardsSupra-annulaire

1981Hancock

1971

Epic JM Intact1983

Bioprothèses porcines stentlessRacines aortiques

FreestyleMedtronic

1992

Prima Edwards

TrifectaSJM

Perimount Carpentier

Edwards1981

Bioprothèses péricardiquesavec stent

Ionescu-Shiley1971

Mitroflow1982

Bioprothèses péricardiques stentless

3f ATSPericarbonSorin

Valves sans suturesThe 3f Enable (Medtronic)

The Perceval S (Sorin)

INTUITY (Edwards Lifesciences)

Mc Govern

Evolution des indications : valve mécanique vs valve biologique

La chirurgie valvulaire en Franceest en expansion

En 1994 : 31% sur 34000 CEC

En 2011 : 45% sur 44718 CEC

La chirurgie valvulaire en France

75% de prothèses biologiquescontre 25% il y a 20 ans

50% de plasties mitralescontre 5% il y a 20 ans

12% de TAVI contre 0% il y a 20 ans