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[Biological versus mechanical valves in the mitral position].
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 1, 1989
Summary
The Björk-Shiley valve showed better long-term event-free survival and freedom from reoperation compared to the Hancock valve in mitral valve replacement patients. Mechanical prostheses are preferred, especially for younger patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomaterials Science
Background:
- Long-term outcomes of prosthetic heart valves are crucial for patient management.
- Comparing mechanical valves like Björk-Shiley (BS) and Hancock (HX) is essential for clinical decision-making.
Purpose of the Study:
- To retrospectively evaluate the long-term late results of isolated mitral valve replacement using Hancock (HX) and Björk-Shiley (BS) valves.
- To compare the survival, thromboembolism, bleeding, endocarditis, and reoperation rates between the two valve types.
Main Methods:
- Retrospective evaluation of 54 patients with Hancock valves and 37 patients with Björk-Shiley valves.
- Total follow-up of 424 patient-years for HX and 366 patient-years for BS.
- Actuarial survival and event-free survival rates were calculated, excluding hospital deaths.
Main Results:
- No significant difference in hospital mortality, thromboembolism, bleeding, or endocarditis between HX and BS groups.
- Actuarial survival at ten years was similar (75.5% HX vs. 80.8% BS).
- Björk-Shiley valves demonstrated significantly higher actuarial freedom from reoperation (93.5% vs. 69.6%) and event-free survival (70.6% vs. 49.2%) at ten years (p < 0.01 and p < 0.05, respectively).
Conclusions:
- The Björk-Shiley mechanical valve showed superior long-term performance regarding reoperation and event-free survival compared to the Hancock valve.
- Mechanical prostheses are preferred, with consideration for biological valves in elderly patients (>65 years) or those with contraindications to anticoagulation.