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Section of tissue or prosthetic valve. A five-year prospective, randomized comparison
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1977
Summary
Tissue valves are a better choice for heart valve replacement than prosthetic valves, offering improved patient survival rates. While functionally similar, homografts reduce morbidity and mortality, especially in aortic positions.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Ongoing debate exists regarding the optimal choice between tissue and prosthetic heart valves.
- Previous comparisons lacked unbiased methodology.
Purpose of the Study:
- To conduct a nonbiased, prospective, randomized comparison of tissue (homograft) versus prosthetic (Starr-Edwards) valves for single valve replacement.
Main Methods:
- Ninety-nine patients with isolated primary single valve replacement were randomized.
- Homografts were used for mitral replacement or aortic roots; Starr-Edwards prostheses served as controls.
- Patient characteristics and outcomes were analyzed actuarially.
Main Results:
- No significant functional or hemodynamic differences were observed between tissue and prosthetic valves.
- Tissue valves demonstrated improved patient morbidity and mortality rates, particularly in the aortic position.
- Starr-Edwards valve failures were linked to fabric wear, thromboembolism, hemorrhage, or infection.
Conclusions:
- Tissue valves (homografts) are recommended over prosthetic valves for improved patient outcomes.
- Glutaraldehyde fixation has significantly reduced tissue deterioration in homografts.
- Prosthetic valves lack comparable advancements in addressing host incompatibility.