Optimal insertion technique for the Björk-Shiley valve in the narrow aortic ostium.

The Björk-Shiley tilting disc valve was used for aortic valve replacement (AVR) in 250 consecutive patients between 1977 and 1982. One hundred and ninety-six patients had isolated AVR, and 54 had combined procedures (double- or triple-valve replacement in 31, associated coronary artery bypass grafting in 20, and miscellaneous procedures in 3). A special technique for inserting large Björk-Shiley valves without using outflow patches or annuloplastic procedures was developed. This method included allowing the right portion of the aortic incision to end about 0.5 cm above the noncoronary sinus; the use of simple interrupted sutures; placement of the prosthetic sewing ring on top of the annulus of the noncoronary sinus, thereby tilting the valve slightly in the outflow tract; and routine orientation of the major opening of the valve toward the annulus of the noncoronary sinus. This orientation resulted in the largest effective orifice area at postoperative catheterization. None of the male patients received a valve smaller than 23 mm, and none of the female patients were given a valve smaller than 21 mm. The convexoconcave model of the Björk-Shiley valve was used in 71% of the patients. An outflow patch was required only in 1 patient with concomitant supravalvular stenosis of the aorta. The combination of adequate myocardial protection, comparatively short aortic cross-clamping times, and the use of large, properly oriented Björk-Shiley valves resulted in satisfactory postoperative hemodynamics in all patients. In fact, none of the 196 patients undergoing isolated AVR and only 5 (9%) of the 54 patients undergoing combined procedures required postoperative inotropic stimulation. There were no operative deaths, and all patients left the hospital in good condition. The Björk-Shiley tilting disc valve is a reliable and well-functioning aortic valve substitute that is particularly suited for patients with narrow aortic ostia. With attention to certain details in the insertion technique, encouraging clinical results can be obtained with this prosthesis.