Comparative Analysis of Mechanical and Bioprosthetic Valves Following Aortic Valve Replacement
Selection of a mechanical or bioprosthetic heart valve should be based on the results of comparative long-term performance characteristics of both types of valves. In order to discern the risk-benefit ratio of mechanical and bioprosthetic valves, the follow-up of 419 patients undergoing aortic valve replacement between 1976 and 1981 was reviewed to determine late valve-related complications. Aortic valve replacement was performed with BJÖRK-SHILEY® (266) or bioprosthetic (porcine 126 and pericardial 27) aortic valves. Cumulative patient follow-up was 1705 patient-years; the mean patient follow-up was 4.1 ± 2.7 years. For all but 11 patients, survival data was obtained for up to 9 years after operation. At 5 years, survival was 81 ± 4% for all valve recipients. Valve failure in the BJÖRK-SHILEY group was predominantly due to valve-related mortality and did not result from structural failure. Patients with bioprosthetic valves experienced valve failure due to prosthetic endocarditis and intrinsic valve degeneration. While patients with bioprosthetic valves experienced a lower incidence of valve-related morbidity than mechanical valve recipients (p < 0.03), no difference between valve types could be demonstrated in the incidence of valve-related mortality or valve failure at 5 years. Mortality due to valve failure was higher for mechanical than bioprosthetic valves (p < 0.01).
KeywordsValve Replacement Aortic Valve Replacement Bioprosthetic Valve Prosthetic Valve Endocarditis Valve Thrombosis
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