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The Björk-Shiley Monostrut valve. Clinical experience in 647 patients
W Daenen1, C Van Kerrebroeck, G Stalpaert
1Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
This study on Björk-Shiley Monostrut valve replacement found that preoperative functional class and bypass time significantly impact mortality. Long-term survival was 81%, with a low rate of thromboembolism.
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Medical Device Performance
Background:
- The Björk-Shiley Monostrut valve was utilized for cardiac valve replacement between 1984 and 1988.
- A significant portion of patients (20.8%) had prior cardiac surgery.
- Understanding the long-term outcomes and risk factors associated with this specific prosthetic valve is crucial for clinical practice.
Purpose of the Study:
- To evaluate the in-hospital and long-term outcomes of patients undergoing valve replacement with the Björk-Shiley Monostrut valve.
- To identify predictors of mortality and thromboembolic events following this procedure.
Main Methods:
- A retrospective analysis of 647 consecutive patients who received a Björk-Shiley Monostrut valve.
- Inclusion of preoperative data, intraoperative variables, and postoperative follow-up.
- Statistical analysis using univariate and multivariate regression to determine significant factors influencing outcomes.
Main Results:
- Overall hospital mortality was 6.8%.
- Actuarial survival at 6 years was 81% ± 4%, with key predictors including preoperative functional class and cardiopulmonary bypass time.
- The actuarial rate of freedom from thromboembolism was 86% ± 4% at 6 years; no valve thrombosis occurred.
Conclusions:
- Preoperative functional class and cardiopulmonary bypass time are significant determinants of mortality after Björk-Shiley Monostrut valve replacement.
- While thromboembolic events were observed, they did not appear to be directly linked to valve thrombosis in this cohort.
- Patients experiencing thromboembolic events had an increased risk of late mortality.
Abstract:
A total of 647 consecutive patients underwent valve replacement with a Björk-Shiley Monostrut valve (Shiley, Inc., Irvine, Calif.) from January 1, 1984, through December 31, 1988. A total of 135 patients (20.8%) had had a previous cardiac correction. Overall hospital mortality was 6.8%. Preoperative functional class, cardiopulmonary bypass time, aortic crossclamping time, and cause of valve replacement influenced in-hospital mortality significantly (univariate analysis). The median follow-up was 30 months. Overall actuarial survival was 81% +/- 4% at 6 years. Univariate and multivariate regression analysis showed that preoperative functional class, total cardiopulmonary bypass time, size of mitral prosthesis, and pure mitral insufficiency significantly influenced total mortality after valve replacement. Additional coronary bypass grafting and redo valve replacement did not. The actuarial rate of freedom from thromboembolism was 86% +/- 4% at 6 years. There were no cases of valve thrombosis. Patients having a thromboembolic event showed a higher probability of late death after native valve replacement.