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A prospective evaluation of the Björk-Shiley, Hancock, and Carpentier-Edwards heart valve prostheses
Insights
This randomized trial compared Björk-Shiley mechanical valves with porcine heterografts (Hancock and Carpentier-Edwards) in 540 patients. While survival and thromboembolism rates were similar, the Carpentier-Edwards prosthesis showed higher in-hospital mortality for mitral valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Trials
Background:
- Mechanical valves (Björk-Shiley) and bioprosthetic valves (porcine heterografts) are used for valve replacement.
- Comparative studies are essential to evaluate prosthesis performance and patient outcomes.
Purpose of the Study:
- To compare the long-term outcomes of Björk-Shiley mechanical valves versus porcine heterograft prostheses (Hancock and Carpentier-Edwards) in patients undergoing valve replacement.
- To assess in-hospital mortality, long-term survival, reoperation rates, and thromboembolism incidence.
Main Methods:
- A randomized trial involving 540 patients from 1975 to 1979.
- Patients received either a Björk-Shiley prosthesis or a porcine heterograft (Hancock or Carpentier-Edwards).
- Data collected included preoperative and operative variables, in-hospital mortality, and long-term follow-up (median 5.6 years).
Main Results:
- In-hospital mortality was similar for aortic and mitral-aortic valve replacement across prostheses.
- Higher in-hospital mortality was observed with the Carpentier-Edwards prosthesis for mitral valve replacement (15.5% vs. 8.8%, p=.03).
- Actuarial survival and thromboembolism rates were not significantly different among prostheses up to 7 years post-surgery.
Conclusions:
- Björk-Shiley mechanical valves and porcine heterografts demonstrate comparable long-term survival and thromboembolism rates.
- The Carpentier-Edwards prosthesis showed a higher in-hospital mortality specifically for mitral valve replacement, warranting further investigation.
- No significant benefit of anticoagulants was observed for porcine prostheses in this study.
Abstract:
From 1975 to 1979, 540 patients undergoing valve replacement were entered into a randomized trial and received either a Björk-Shiley (273 patients) or a porcine heterograft prosthesis (initially a Hancock valve [107 patients] and later a Carpentier-Edwards prosthesis [160 patients]). Two hundred and sixty-two patients required mitral valve replacement, 210 required aortic valve replacement, 60 required mitral and aortic valve replacement, and eight also required associated tricuspid valve replacement (six mitral valve replacement; two mitral plus aortic valve replacement). Analysis of 34 preoperative and operative variables showed the treatment groups to be well randomized. In-hospital mortality was not significantly different among patients receiving the three prostheses for aortic valve replacement (7.6% overall) and mitral plus aortic valve replacement (10% overall), but there was a higher in-hospital mortality for patients undergoing mitral valve replacement with the Carpentier-Edwards prosthesis (15.5% compared with 8.8% overall; p = .03). This difference could not be explained on the basis of any preoperative or operative variable. Median follow-up was 5.6 (range 2.8 to 8.3) years. Actuarial survival after mitral valve replacement was 56.7 +/- 7.0% at 7 years, that after aortic valve replacement was 69.6 +/- 9.6% at 7 years, and that after mitral plus aortic valve replacement was 62.5 +/- 20.0% at 7 years. There was no significant difference in actuarial survival of patients receiving the three prostheses within the mitral, aortic, and mitral plus aortic valve replacement groups, nor was there a difference when these groups were amalgamated. Thirty-seven patients required reoperation for valve failure (15 with Björk-Shiley, 12 with Hancock, and 10 with Carpentier-Edwards valves; p = NS) and 11 died at reoperation (four with Björk-Shiley, four with Hancock, and three with Carpentier-Edwards valves; overall operative mortality 29.7%). Up to 7 years after surgery, there was no significant difference in the incidence of thromboembolism in patients with different prostheses undergoing mitral or aortic valve replacement. There were too few patients undergoing mitral plus aortic valve replacement for meaningful comparison. There was no significant beneficial effect of anticoagulants in patients undergoing mitral or aortic valve replacement with porcine prostheses, but patients were not randomly allocated to anticoagulant treatment. All patients with Björk-Shiley prostheses received anticoagulants.(ABSTRACT TRUNCATED AT 400 WORDS)