Mitral valve replacement with the Hancock, Björk-Shiley and Lillehei-Kaster prostheses. A comparison based on a 15-year follow-up
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A Milano1, U Bortolotti, A Mazzucco
1Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Insights
Comparing three mitral valve prostheses over 15 years, Hancock porcine bioprosthesis showed higher tissue degeneration, while mechanical Björk-Shiley and Lillehei-Kaster prostheses had more dysfunction and reoperations. Long-term outcomes varied significantly.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Performance Evaluation
Background:
- Mitral valve replacement is a critical procedure for heart failure management.
- Bioprosthetic and mechanical valves offer different long-term risk-benefit profiles.
- Comparative data on long-term outcomes of specific mitral valve prostheses are essential for clinical decision-making.
Purpose of the Study:
- To compare the 15-year performance of Hancock porcine bioprosthesis (HPB), Björk-Shiley spherical disc prosthesis (BSP), and Lillehei-Kaster tilting disc prosthesis (LKP) after isolated mitral valve replacement.
- To evaluate differences in prosthetic dysfunction, reoperations, bleeding, and survival among the three valve types.
- To determine the long-term durability and complication rates associated with each prosthesis in the mitral position.
Main Methods:
- A 15-year follow-up study involving 502 HPB, 183 LKP, and 119 BSP recipients undergoing isolated mitral valve replacement.
- Analysis of cumulative patient-years for each prosthesis group (HPB: 3,488; LKP: 1,302; BSP: 718).
- Statistical comparison of freedom from anticoagulant-related haemorrhages, prosthetic dysfunction, reoperations, and prosthetic failure at 15 years.
Main Results:
- Significant differences were observed in freedom from prosthetic dysfunction (HPB 42% vs. BSP 96%, LKP 83%), overall reoperations (HPB 40% vs. BSP 94%, LKP 89%), and prosthetic failure (HPB 38% vs. BSP 88%, LKP 71%) at 15 years (P < 0.001).
- HPB recipients experienced significantly fewer anticoagulant-related haemorrhages (83%) compared to BSP recipients (65%) (P < 0.05).
- No significant differences were found in actuarial survival, freedom from thromboembolic episodes, treatment failure, or overall prosthesis-related complications.
Conclusions:
- The long-term performance of the Hancock porcine bioprosthesis in the mitral position is limited by a high incidence of tissue degeneration.
- Mechanical prostheses (BSP and LKP) demonstrate superior durability but are associated with increased risks of dysfunction, reoperations, and prosthetic failure.
- Haemorrhagic complications associated with mechanical valves may offset their longer durability, highlighting the trade-offs between bioprosthetic and mechanical mitral valve replacement.
Abstract:
The performance of the standard Hancock porcine bioprosthesis (HPB), the Björk-Shiley spherical disc prosthesis (BSP) and the Lillehei-Kaster tilting disc prosthesis (LKP) was compared over a 15-year follow-up in patients who underwent isolated mitral valve replacement (502 HPB, 183 LKP and 119 BSP). The cumulative duration of follow-up is 3,488 patient-years (mean, 8.0 +/- 3.7 years) for patients with a HPB, 1,302 patient-years (mean, 8.4 +/- 4.9 years) for patients with a LKP and 718 patient-years (mean, 7.1 +/- 5.6 years) for those with a BSP. At 15 years a significant difference was found among the 3 groups in freedom from (1) anticoagulant-related haemorrhages, between HPB (83% +/- 7%) and BSP (65% +/- 8%) recipients (P less than 0.05); (2) prosthetic dysfunction, BSP (96% +/- 3%) and LKP (83% +/- 6%) versus HPB (42% +/- 5%) recipients (P less than 0.001); (3) overall reoperations, BSP (94% +/- 3%) and LKP (89% +/- 3%) versus HPB (40% +/- 5%) recipients (P less than 0.001) and (4) prosthetic failure, BSP (88% +/- 4%) and LKP (71% +/- 6%) versus HPB (38% +/- 5%) recipients (P less than 0.001). No difference was found in actuarial survival, freedom from thromboembolic episodes, treatment failure and overall prosthesis-related complications. Our results confirm that the long-term performance of the HPB in the mitral position is adversely affected by the high incidence of tissue degeneration while haemorrhagic complications may limit the advantage of the longer durability of mechanical prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)