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[Comparative analysis of long-term results with porcine-aortic, bovine pericardial and tilting disc valves]
K Kawazoe1, O Kawaguchi, Y Kosakai
1Dept. of Surgery Natinal Cardiovascular Center, Suita, Japan.
Insights
Björk-Shiley mechanical valves demonstrated comparable long-term survival and thromboembolism rates to bioprosthetic valves in aortic and mitral replacements. However, the Ionescu-Shiley pericardial xenograft showed higher dysfunction rates.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Medicine
Background:
- First-generation prosthetic heart valves have been widely used for aortic and mitral valve replacement.
- Long-term clinical evaluation is crucial for understanding the durability and performance of these early prostheses.
Purpose of the Study:
- To conduct a long-term clinical evaluation of three first-generation prosthetic heart valves in isolated aortic and mitral valve replacement.
- To compare the clinical performance and durability of Hancock porcine xenografts, Ionescu-Shiley pericardial xenografts, and Björk-Shiley tilting disc valves.
Main Methods:
- Retrospective review of patients who received Hancock porcine xenografts (n=71, 1977-1979), Ionescu-Shiley pericardial xenografts (n=271, 1979-1983), and Björk-Shiley tilting disc valves (n=194, 1978-1986).
- Actuarial analysis of survival, freedom from thromboembolism, valve infection, and valve dysfunction for each valve type in aortic and mitral positions.
Main Results:
- In aortic position, no significant differences were observed in actuarial survival, freedom from thromboembolism, or valve infection among the three valve types.
- The Ionescu-Shiley valve showed a significantly lower actuarial freedom from valve dysfunction compared to the other two valves.
- In mitral position, the Björk-Shiley valve demonstrated satisfactory clinical performance regarding complications and survival compared to the bioprosthetic valves.
Conclusions:
- The Björk-Shiley tilting disc valve is recommended as a suitable first choice for both aortic and mitral valve prostheses.
- For bioprosthetic valve replacement, porcine aortic valves are preferable for aortic position, and bovine pericardial valves for mitral position.
Abstract:
The three series with the first-generation valve prostheses were reviewed for long-term clinical evaluation in isolated aortic and mitral valve replacement. Hancock porcine xenograft was implanted in 71 patients from 1977 to 1979, ionescu-Shiley pericardial xenograft (standard model) in 271 patients from 1979 to 1983, and Bjork-Shiley tilting disc valve in 194 from 1978 to 1986. In aortic position, no any significant difference among three valve types could be demonstrated in the actuarial survival and freedom from thromboembolism and valve infection, while the actuarial freedom from valve dysfunction in lonescu-Shiley valve was significantly lower than that in other two valves. Björk-Shiley valve in mitral position showed satisfactory clinical performance in terms of valve-related complications and survival in comparison with two types of bioprosthetic valves. In our conclusion at present time, Björk-Shiley valve is suitable for the first choice of both aortic and mitral valve prostheses. In case of valve replacement with a bioprosthesis, however, porcine aortic valve is a better choice for aortic, and bovine pericardial valve likely for mitral replacement.