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Clinical comparison of St. Jude and porcine mitral valve prostheses
P S Douglas1, J W Hirshfeld, R N Edie
1Cardiovascular Section, Hospital of the University of Pennsylvania, Philadelphia.
Insights
This study compared St. Jude and porcine mitral valves after replacement surgery. Both valve types demonstrated similar clinical performance, symptomatic improvement, and survival rates in patients over intermediate follow-up.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Mitral valve replacement is a common procedure to restore heart function.
- Choosing between mechanical (St. Jude) and bioprosthetic (porcine) valves involves balancing durability, thrombogenicity, and other complications.
- Comparative studies are essential for guiding clinical decision-making in mitral valve prostheses.
Purpose of the Study:
- To prospectively compare the clinical performance and complication rates of St. Jude mechanical valves and porcine heterograft valves in mitral valve replacement.
- To evaluate differences in symptomatic improvement, mortality, and specific valve-related complications between the two prosthesis types.
Main Methods:
- A prospective study of 106 consecutive patients undergoing mitral valve replacement with either St. Jude or porcine prostheses.
- Patients were analyzed for 67 clinical and operative factors to ensure group comparability.
- Follow-up data, totaling 3,312 patient-months, were collected to assess valve performance and complications using life table analysis.
Main Results:
- No statistically significant differences were observed in symptomatic improvement or overall mortality between the St. Jude and porcine valve groups.
- Valve-related complication rates (reoperation, endocarditis, regurgitant murmur, hemolysis, thromboembolism, hemorrhage, valve failure) showed no significant differences between the groups.
- Actuarial survival at 3 years was comparable (78% for St. Jude, 81% for porcine), with similar rates of patients alive and free of complications.
Conclusions:
- The St. Jude mechanical valve and porcine heterograft valve exhibit similar clinical performance in mitral valve replacement patients over an intermediate follow-up period.
- Both valve types provide comparable symptomatic relief and survival rates, suggesting patient selection may depend on other factors.
- Further long-term studies may be warranted to assess durability and late complications for both mitral valve prostheses.
Abstract:
One hundred and six consecutive patients who had mitral valve replacement with either a St. Jude or porcine heterograft prosthesis were prospectively studied. The 2 groups are similar with respect to 67 clinical and operative factors and allow comparison of valve performance as an independent variable. Total follow-up is 3,312 patient-months (mean 36 months, range 2-57 months, 94% complete). There are no statistical differences in symptomatic improvement or mortality by life table analysis. Valve-related complications expressed as percent per patient-year are: reoperation: 1.8 St. Jude and 3.8 porcine; endocarditis: 1.2 and 1.9; regurgitant murmur: 2.3 and 1.9; hemolysis: 1.8 and 0.0; late thromboembolism: 1.8 and 1.0; hemorrhage: 2.9 and 2.9; and valve failure: 0.0 and 1.0. There were no significant differences found. Actuarial survival at 3 years was 78% in St. Jude and 81% in porcine patients. Forty-six percent of patients with St. Jude valves and 55% of patients with porcine valves were alive and free of all complications at latest follow-up. The clinical performance of St. Jude and porcine mitral valves are similar over this period of intermediate follow-up.