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Aortic valve replacement. A randomized study comparing the Björk-Shiley and Lillehei-Kaster disc valves. Long-term
Insights
The Björk-Shiley (B-S) valve showed a higher 7-year survival rate and lower sudden death incidence compared to the Lillehei-Kaster (L-K) valve in aortic positions. Patient return to work was also higher with B-S valves.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Aortic valve replacement is a critical procedure for patients with severe aortic valve disease.
- Comparing the long-term efficacy and safety of different prosthetic valves is essential for optimizing patient care.
- The Björk-Shiley (B-S) and Lillehei-Kaster (L-K) valves are mechanical prostheses used in aortic valve replacement.
Observation:
- A randomized study compared 300 patients receiving either B-S or L-K aortic valves with a mean follow-up of 4.75 years.
- Late mortality was higher in the L-K group (23 deaths) than the B-S group (15 deaths).
- Sudden, unexpected deaths were significantly more frequent in the L-K group (10:1 ratio).
Findings:
- The 7-year actuarial survival rate was 82% for B-S valves versus 76% for L-K valves.
- Survival rates were better with larger valve sizes, particularly significant in the L-K group (p<0.02).
- Thromboembolic rates were similar (3.2/100 patient-years for B-S, 2.8/100 patient-years for L-K), with 3 B-S and 4 L-K valve thromboses observed.
Implications:
- The Björk-Shiley valve demonstrated superior long-term survival and reduced sudden death risk compared to the Lillehei-Kaster valve in aortic positions.
- Functional capacity, assessed by NYHA classification, strongly correlated with return-to-work rates, highlighting the importance of valve performance on quality of life.
- These findings may inform future prosthetic valve selection for aortic valve replacement, prioritizing patient survival and functional recovery.
Abstract:
Three hundred patients were selected at random in order to compare the Björk-Shiley (B-S) and Lillehei-Kaster (L-K) valves in the aortic position. The mean follow-up time was 4 3/4 years (range 3 1/4-7 years). There were 15 late deaths in the B-S group and 23 in the L-K group. The incidence of sudden and unexpected deaths was much higher in the L-K than in the B-S group (10:1). The 7-year actuarial survival rate was 82% in the B-S and 76% in the L-K group. In both groups the survival rate was higher in patients with large valves than in those with small valves; in the L-K group this difference was significant (p less than 0.02). The overall thrombo-embolic rate was 3.2 per 100 patient years in the B-S and 2.8 in the L-K group. Valve thrombosis occurred in 3 patients with B-S valves and in 4 with L-K vales. One of the L-K valves was thrombosed early after operation due to faulty suture technique. Of the long-term survivors of working age 80% in the B-S and 70% in the L-K group returned to work. There was a close correlation between functional capacity (NYHA) and the employment rate.