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A comparative study in patients with Omnicarbon and Björk-Shiley heart valve replacement
1Osaka National Hospital, Japan.
Insights
The Omnicarbon heart valve demonstrated comparable operative and hemodynamic results to the Björk-Shiley valve, though the latter showed a slightly better aortic closure to mitral opening click interval.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Mitral valve replacement is a critical procedure for managing severe mitral valve disease.
- Comparing prosthetic heart valves is essential for optimizing patient outcomes.
- The Omnicarbon and Björk-Shiley valves represent different designs for mitral valve prostheses.
Purpose of the Study:
- To compare the clinical performance of the Omnicarbon heart valve against the Björk-Shiley spherical valve after mitral valve replacement.
- To evaluate operative results, hemodynamic parameters, and long-term outcomes for both valve types.
Main Methods:
- Comparative analysis of patient data following mitral valve replacement with either Omnicarbon or Björk-Shiley valves.
- Assessment of early and late mortality, survival rates, and valve-related complications.
- Hemodynamic evaluation using pressure gradients, effective mitral valve areas, cardiac index, and Doppler echocardiography.
- Phonocardiographic analysis of valve click intervals (AC-OpC, Q-CC) and assessment of hemolysis.
Main Results:
- No early deaths were observed in either group; late deaths occurred in 6 Omnicarbon patients (2.9% per patient-year).
- Actuarial survival at 6 years was 82.1% for Omnicarbon, with 86.4% freedom from valve-related complications.
- Hemodynamic parameters at rest were satisfactory for both valves; however, Omnicarbon showed a significant decrease in cardiac index at 160 bpm.
- Regurgitant flow was noted in 28% of Omnicarbon patients versus 10% of Björk-Shiley patients at 160 bpm (p=ns).
- The Björk-Shiley valve demonstrated a statistically significant shorter aortic closure to mitral opening click (AC-OpC) interval (70.9 msec vs 76.8 msec, p < 0.05).
- Hemolysis was clinically insignificant in Omnicarbon valves with intact function.
Conclusions:
- Both Omnicarbon and Björk-Shiley valves provide satisfactory hemodynamic function post-mitral valve replacement.
- The Björk-Shiley valve exhibited a slight advantage in the AC-OpC interval, suggesting potentially better valve dynamics.
- Long-term survival and complication rates were comparable, indicating acceptable performance for both prostheses, though further investigation into regurgitant flow differences may be warranted.
Abstract:
To compare the Omnicarbon heart valve and the Björk-Shiley spherical valve, operative results, hemodynamic parameters and late results were examined after mitral valve replacement. There were no early deaths, and 6 late deaths in the Omnicarbon valve (2.9% per patient-year). The actuarial survival rate at 6 years was 82.1 +/- 4.8% and freedom from valve-related complications was 86.4 +/- 2.2%. Pressure gradients and effective mitral valve areas at rest calculated by Gorlin's formula were satisfactory in both valve. Cardiac index (l/min/m2) was slightly changed according to the pacer-induced tachycardia, but there was a significant decrease in 160 bpm in the Omnicarbon valve (2.01 vs 2.39, p < 0.05). Peak pressure gradients and pressure half time by Doppler echocardiography, revealed the same trends as those of the Björk-Shiley valve during tachycardiac exercise, though regurgitant flow was detected in 7 patients in 160 bpm in the Omnicarbon valve, while in 2 in the Björk-Shiley valve (28% vs 10%, p = ns). Phonocardiographic study demonstrated that aortic closure to mitral opening click (AC-OpC) interval and Q wave of the electrocardiogram to mitral closing click (Q-CC) interval, which were related to the mitral valve gradients, fell within the normal range in both valves. However, the Björk-Shiley valve compared favorable to the Omnicarbon valve in the AC-OpC interval (70.9 msec vs 76.8 msec, p < 0.05). Hemolysis was of no clinical importance in the intact function of the Omnicarbon valve.(ABSTRACT TRUNCATED AT 250 WORDS)