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Noninvasive, In-pen Approach Test for Laboratory-housed Pigs
Published on: June 5, 2019
Actuarial comparison of Hancock porcine and prosthetic disc valves for isolated mitral valve replacement
Insights
For mitral valve replacement (MVR), porcine valves significantly reduced mortality and thromboemboli compared to disc valves. Anticoagulation is recommended for patients with atrial fibrillation and enlarged atria, irrespective of valve type.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Mitral valve replacement (MVR) is a critical procedure for managing severe mitral valve disease.
- Prosthetic valves, including mechanical disc valves and bioprosthetic porcine valves, offer different risk-benefit profiles.
Purpose of the Study:
- To compare the outcomes of isolated mitral valve replacement using Harken prosthetic disc valves (DVR) versus glutaraldehyde-preserved Hancock porcine xenografts (PVR).
- To evaluate the incidence of mortality and thromboembolic events in patients receiving either valve type.
Main Methods:
- A retrospective analysis of 109 patients undergoing isolated MVR between July 1970 and December 1974.
- Patients were divided into two groups: 53 receiving DVR and 56 receiving PVR.
- Outcomes including operative/late deaths and thromboembolic events were compared, with specific attention to anticoagulant use and patient characteristics like atrial fibrillation and left atrial size.
Main Results:
- The PVR group experienced no operative deaths and 3 late deaths (5.5%), while the DVR group had 2 operative deaths and 10 late deaths (19.5%).
- Thromboembolic events were lower in the PVR group (10%, all nonfatal) compared to the DVR group (26.4%, including fatal events).
- Anticoagulants were not used in the PVR group, whereas they were used in the DVR group.
Conclusions:
- The use of porcine xenografts for MVR is associated with significantly reduced morbidity and mortality, primarily due to a lower risk of thromboemboli.
- Regardless of the prosthetic valve used, anticoagulation is advised for patients with atrial fibrillation and enlarged left atria to mitigate embolic risk.
Abstract:
From July 1970 through December 1974, 109 patients underwent isolated mitral valve replacement (MVR). A Harken prosthetic disc valve (DVR) was used in 53 patients and glutaraldehyde-preserved Hancock porcine xenograft (PVR) in 56 patients. The functional class, distribution of mitral valve pathology, and incidence of atrial fibrillation were similar in both groups. There were no operative and three (5.5%) late deaths in the PVR group and two (3.8%) operative and ten (19.5%) late deaths in the DVR group. Anticoagulants were not used in the PVR group; there were 3 nonfatal emboli (10%), all occurring in patients with atrial fibrillation and large left atria. Although anticoagulants were used there were 14 emboli (five in patients who died, nine nonfatal) in the DVR group (26.4%). In our experience, there is a significant reduction in morbidity and mortality, primarily from a reduced risk of thromboemboli, if a porcine valve is used for MVR. Anticoagulants should be used in patients with atrial fibrillation and enlarged left atria regardless of the type of valve used.
