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The Björk-Shiley valve: intermediate-term follow-up
Insights
The Björk-Shiley valve shows durability and effectiveness in valve replacement surgery. However, patient factors significantly impact long-term survival, alongside risks of thromboembolism and valve thrombosis.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- The Björk-Shiley mechanical valve has been used for decades in aortic and mitral valve replacement.
- Understanding long-term outcomes and associated risk factors is crucial for patient management.
Purpose of the Study:
- To evaluate the intermediate-term survival and complication rates of the Björk-Shiley prosthesis.
- To identify factors influencing late survival after aortic, mitral, or double valve replacement.
Main Methods:
- A cohort of 643 patients undergoing Björk-Shiley valve replacement was followed for 1-72 months (median 38 months).
- Survival rates, thromboembolism, valve thrombosis, and functional class improvement were analyzed.
- Multivariate analysis identified factors associated with late survival.
Main Results:
- Intermediate-term survival was comparable to other prosthetic devices.
- Patient-related factors (previous valve surgery, race, functional class) and perioperative events significantly impacted survival.
- Freedom from thromboembolism was favorable, but valve thrombosis occurred in 15 patients, causing 13 deaths.
- Most patients showed improvement in New York Heart Association (NYHA) functional class.
Conclusions:
- The Björk-Shiley valve is durable and effective for valve replacement.
- Thromboembolism and thrombosis remain significant concerns, necessitating careful patient selection and monitoring.
- Non-device patient characteristics are critical determinants of long-term survival after valve replacement.
Abstract:
We evaluated 643 patients surviving aortic, mitral, and aortic and mitral ("double") valve replacement with the Björk-Shiley prosthesis from 1 to 72 months (median 38 months) postoperatively. Intermediate-term survival rate was similar to that reported for other prosthetic and bioprosthetic devices. Factors unrelated to the device, but related to preoperative patient characteristics or intraoperative or early postoperative events, had important association with late survival rate. These included previous valve replacement, concomitant ventricular aneurysm resection, black race, preoperative functional class, method of myocardial protection, duration of ischemic arrest, ventricular arrhythmias, and double valve replacement. Concomitant coronary artery bypass grafting and the type of valve lesion had no effect on survival prognosis. Freedom from thromboembolism was equal to or superior to other devices, but valve thrombosis occurred 16 times in 15 patients and caused 13 deaths. Improvement in New York Heart Association (NYHA) functional class occurred in the majority of patients. We conclude that the Björk-Shiley valve is durable and effective, but, as with other devices, is associated with problems of thromboembolism and thrombosis. Intermediate-term survival is related also to non-device, patient-associated characteristics.