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Combined mitral and aortic valve replacement with Bjørk-Shiley prostheses: long term survival and valve-related
1Broadgreen Hospital, Liverpool, United Kingdom.
Insights
This study evaluated Bjork-Shiley valve outcomes in 209 patients undergoing combined aortic and mitral valve replacement (DVR). While overall survival reached 74% at 12 years, high-risk patients faced poorer prognoses.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Combined aortic and mitral valve replacement (DVR) is a complex procedure.
- The Bjork-Shiley tilting-disc prosthesis was widely used during the study period.
- Understanding long-term outcomes and complications is crucial for patient management.
Purpose of the Study:
- To assess the early and late mortality and survival rates following DVR using Bjork-Shiley prostheses.
- To identify factors influencing mortality and valve-related complications.
- To evaluate freedom from reoperation and compare patient-related valve failure rates with other prosthesis types.
Main Methods:
- Retrospective analysis of 209 patients undergoing DVR between 1974 and 1985.
- Utilized Bjork-Shiley tilting-disc prostheses for both aortic and mitral valve replacements.
- Statistical analysis of mortality, survival, complications, and reoperation rates.
Main Results:
- Overall early and late mortality were 9.5% and 10.5%, respectively.
- Emergency DVR, NYHA Class IV, double valve replacement, critical stenosis, and small prosthesis size were associated with higher early mortality.
- Twelve-year overall survival was 74%, but only 40% at 8 years for NYHA Class IV patients.
- Freedom from valve-related complications at 12 years was 77%, with specific rates for disc occlusion, hemorrhage, endocarditis, thromboembolism, and paravalvular leak.
- Freedom from reoperation was 95% at 5 and 12 years.
Conclusions:
- Bjork-Shiley prostheses demonstrated acceptable long-term outcomes in DVR, with low reoperation rates.
- Patient-related valve failure rates were comparable to other mechanical prostheses and lower than bioprostheses.
- Preoperative patient status and prosthesis characteristics significantly impact early mortality and long-term survival.
Abstract:
Between 1974 and 1985, combined aortic and mitral valve replacement (DVR) was performed in 209 patients using Bjørk-Shiley tilting-disc prostheses. Early and late mortality were 9.5% and 10.5% respectively for the entire series. Factors significantly influencing early mortality were: Emergency DVR, preoperative NYHA Class IV, double valve, critical stenosis, and small aortic replacement prostheses. The effect of the latter was augmented by the suboptimal orientation of the implanted prostheses. The overall survival was 74 +/- 4.4% at 12 years; but was only 40 +/- 6.1% at 8 years in patients who were in NYHA class IV preoperatively. Intermittent disc occlusion (DO) and thrombotic disc occlusion (TO), presented as early, anticoagulant related haemorrhage (AH) and prosthetic valve endocarditis (ENDO) as sporadic, and thromboembolism (TE) and paravalvular leak (PVL) as continuous risk factors. Freedom from all known valve-related complications was 77 +/- 4.5% at 12 years (DO, TO, AH, ENDO, TE, PVL: 98%, 97%, 96%, 96%, 88% and 89% respectively). Lethal DO and TO occurred in mitral prostheses. Freedom from reoperation was 95% at 5 and 12 years. Patient-related valve failure rate in this series is comparable with the other series which used mechanical prostheses and is lower than those which used bioprostheses.