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[Late complications following Björk-Shiley and Carpentier-Edwards heart valve replacements]
Insights
Björk-Shiley mechanical valves showed better long-term event-free survival than Carpentier-Edwards bioprosthetic valves, especially in patients under 40. Bioprosthetic degeneration was a key issue for Carpentier-Edwards valves.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Valve Research
Background:
- Mechanical heart valves like Björk-Shiley and bioprosthetic valves like Carpentier-Edwards are used for valve replacement.
- Complications and long-term outcomes differ between prosthetic valve types.
- Understanding these differences is crucial for patient selection and surgical planning.
Purpose of the Study:
- To compare valve-related complications and survival rates between Björk-Shiley and Carpentier-Edwards valve replacements.
- To evaluate the long-term event-free survival, particularly in younger patients.
- To identify the primary causes of complications in Carpentier-Edwards valve recipients.
Main Methods:
- Retrospective analysis of patients who underwent valve replacement between 1976-1982.
- Comparison of Björk-Shiley (n=50) and Carpentier-Edwards (n=113) valve groups.
- Follow-up until 1985 to assess survival and complications, including valve degeneration.
Main Results:
- Overall survival rates were similar between Björk-Shiley and Carpentier-Edwards valves.
- Event-free survival was significantly worse for Carpentier-Edwards valves in patients under 40 (46%) compared to Björk-Shiley valves (100%).
- Bioprosthetic degeneration was the main complication for Carpentier-Edwards valves, diagnosed at a mean of 73 months post-surgery.
Conclusions:
- Björk-Shiley mechanical valves offer superior event-free survival in younger patients (<40 years) compared to Carpentier-Edwards bioprosthetic valves.
- Bioprosthetic degeneration is a significant long-term concern for Carpentier-Edwards valves.
- Valve selection should consider patient age and the risk of specific complications.
Abstract:
Valve related and valve induced, fatal or non fatal complications after Björk-Shiley valve replacement (n = 50) are compared with complications following Carpentier-Edwards valve replacement (n = 113). These patients had been operated upon between 1976 and 1982 and were followed up until 1985. Estimated actuarial cumulative survival following Carpentier-Edwards valve replacement (53 +/- 12% after a 100-month period) did not differ significantly from the estimate following Björk-Shiley valve replacement (80 +/- 6% after a 100-month-period), and subgroups of the cohort did not differ in survival after Carpentier-Edwards or Björk-Shiley valve replacement either. However, the estimate of actuarial cumulative event-free survival following Carpentier-Edwards valve replacement in patients under 40 years of age (46 +/- 14% after a 92-month period) was significantly worse (p less than 0.05) than with Björk-Shiley valves (100 +/- 0% after a 92-month period), (n = 30). The leading cause of clinical complications following Carpentier-Edwards valve replacement was a demonstrable degeneration of the bioprosthesis in 12 cases. The diagnosis of degeneration was established a mean of 73 months postoperatively (range 42-101 months).