What is the clinical evidence from this study?

Study design: Case Report. Population: Subaortic stenosis due to pannus formation (n=1). Intervention: Revision aortic valve replacement with a Perceval sutureless valve. Primary outcome: Clinical recovery and valve hemodynamics.

What does this research mean for the field?

The Björk–Shiley monostrut valve maintains exceptional structural durability up to 40 years post-implantation, though long-term surveillance remains necessary due to the risk of non-valvular complications such as pannus formation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To report a case of aortic valve reoperation due to complications from a long-term implanted mechanical valve.

May 29, 2026Journal of Medical Case Reports0 citationsOpen Access

Revision aortic valve replacement with a Perceval sutureless valve 40 years after Björk–Shiley monostrut valve: a case report

YMYasuhiro Matsuda TKTadaaki Koyama

Key Result

An 80-year-old man successfully underwent revision aortic valve replacement with a Perceval sutureless valve for subaortic stenosis caused by pannus formation 40 years after Björk-Shiley valve implantation.

Key Points

To report a case of aortic valve reoperation due to complications from a long-term implanted mechanical valve.
An 80-year-old man with a Björk–Shiley monostrut valve underwent echocardiography and surgical intervention.
The patient was treated with a Perceval sutureless valve and other cardiac procedures.
Postoperative follow-up included echocardiography to assess valve function.
The patient had satisfactory valve hemodynamics postoperatively, with improved ventricular function.
At 8 months post-surgery, there were no signs of prosthetic valve dysfunction.
The patient recovered from pneumonia and was transferred to rehabilitation by day 21.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 80-year-old Japanese man with a Björk–Shiley monostrut valve implanted in the aortic position 40 years earlier, presenting with syncope, progressive heart failure, severe aortic stenosis (due to subvalvular pannus formation), moderate mitral stenosis, moderate tricuspid regurgitation, significantly reduced ejection fraction, and a history of bradycardic atrial fibrillation.

Intervention

Aortic valve re-replacement with a Perceval sutureless valve, mitral valve replacement, tricuspid annuloplasty, and left atrial appendage closure.

Outcome

Clinical recovery, valve hemodynamics, and ventricular function at follow-up

This case demonstrates the exceptional 40-year structural durability of the Björk–Shiley monostrut valve and the utility of sutureless valves to minimize ischemia time during complex reoperations.

Abstract

Abstract Background The Björk–Shiley monostrut (BS-M) valve, a tilting-disc mechanical prosthesis introduced to improve durability and reduce structural failure, has demonstrated excellent long-term outcomes in the aortic position. Although structural valve deterioration is rare, non-valvular complications such as pannus formation can necessitate reoperation. We report a rare case of revision aortic valve replacement 40 years after BS-M implantation due to subaortic stenosis caused by pannus formation, utilizing a Perceval sutureless valve to minimize operative risk in the context of impaired cardiac function. Case presentation An 80-year-old Japanese man with a BS-M valve implanted in the aortic position 40 years earlier presented with syncope and progressive heart failure. He had a history of bradycardic atrial fibrillation and had been managed medically for heart failure over the preceding seven years. Transthoracic echocardiography revealed severe aortic stenosis, moderate mitral stenosis, and moderate tricuspid regurgitation, with a significantly reduced ejection fraction. Although the BS-M valve itself exhibited no mechanical damage or disc dysfunction intraoperatively, circumferential pannus formation beneath the prosthesis caused significant subvalvular stenosis. The patient underwent aortic valve re-replacement with a Perceval™ sutureless valve, mitral valve replacement, tricuspid annuloplasty, and left atrial appendage closure. The choice of a sutureless valve was made to reduce myocardial ischemia time. Postoperatively, the patient experienced aspiration pneumonia requiring reintubation; however, he recovered and was transferred to rehabilitation on postoperative day 21. Follow-up echocardiography revealed satisfactory valve hemodynamics and improved ventricular function, with no evidence of prosthetic valve dysfunction. At 8-month follow-up, the patient remained well. Conclusions This case highlights the exceptional structural durability of the BS-M valve even after four decades. Nonetheless, non-valvular complications such as pannus formation may necessitate reoperation. Long-term surveillance remains essential for early detection of functional decline, even in patients with structurally intact prosthetic valves.

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