BACKGROUND. Patients undergoing heart-valve replacement may receive a mechanical prosthesis, necessitating lifelong anticoagulant treatment, or a porcine bioprosthesis, which involves no absolute need for anticoagulants. METHODS. We carried out a randomized, prospective trial to compare the durability of the Bjork-Shiley mechanical prosthesis (spherical tilting-disk model) and the incidence of valve-related complications with those variables in the Hancock and the Carpentier-Edwards porcine prostheses. The mitral valve was replaced in 261 patients, the aortic valve in 211, and both in 61; the survivors have been followed up for a mean of 12 years. RESULTS. We found a trend toward improved actuarial survival after 12 years with the Bjork-Shiley prosthesis, but this trend was not statistically significant (group with Bjork-Shiley valve vs. group with porcine valve [mean +/- SE], 51.5 +/- 3.2 vs. 44.4 +/- 3.2 percent; P = 0.08). There was no significant difference in the actuarial incidence of reoperation after 5 years, but after 12 years significantly more patients with a porcine prosthesis had undergone reoperation (8.5 +/- 2.0 vs. 37.1 +/- 4.1 percent, P less than 0.001). An analysis combining death and reoperation as end points for an actuarial assessment of survival with the original prosthesis intact confirmed that the patients with Bjork-Shiley Shiley prostheses had improved survival (48.6 +/- 3.2 vs. 30.0 +/- 3.0 percent after 12 years, P less than 0.001). Bleeding requiring hospitalization or blood transfusion was significantly more frequent in the patients with Bjork-Shiley prostheses (18.6 +/- 3.2 vs. 7.1 +/- 2.3 percent after 12 years, P less than 0.01). There was no significant difference after 12 years in the actuarial occurrence of embolism (Bjork-Shiley vs. porcine, 21.1 +/- 3.1 vs. 26.4 +/- 3.5 percent) or endocarditis (3.7 +/- 1.4 vs 4.6 +/- 1.6 percent). CONCLUSIONS. Survival with an intact valve is better among patients with the Bjork-Shiley spherical tilting-disk prosthesis than among patients with porcine bioprostheses, but use of the Bjork-Shiley valve carries an attendant increased risk of bleeding associated with the need for anticoagulant treatment.
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Department of Cardiology, Royal Infirmary of Edinburgh, Scotland.
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
Gregoric, I., Conger, J. L., Reul, H., Tamez, D., Clubb, F. J. Jr, Stainback, R. F., Hernandez, A., Cervera, R., Eya, K., Byler, D., Kadipasaoglu, K. A., Frazier, O. H.
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[Abstract][Full Text]
Paez, J. M. G., Herrero, E.J., Rocha, A., Maestro, M., Castillo-Olivares, J. L., Millan, I., Sanmartin, A. C., Cordon, A.
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[Abstract]
Bach, D. S.
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[Abstract][Full Text]
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76: 66-73
[Abstract][Full Text]
Taylor, K M
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89: 697-698
[Full Text]
Oxenham, H, Bloomfield, P, Wheatley, D J, Lee, R J, Cunningham, J, Prescott, R J, Miller, H C
(2003). Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart
89: 715-721
[Abstract][Full Text]
Hanania, G
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89: 481-482
[Full Text]
Rahimtoola, S. H.
(2003). Choice of prosthetic heart valve for adult patients. J Am Coll Cardiol
41: 893-904
[Abstract][Full Text]
Grunkemeier, G. L., Wu, Y.
(2003). "Our complication rates are lower than theirs": Statistical critique of heart valve comparisons. J. Thorac. Cardiovasc. Surg.
125: 290-300
[Abstract][Full Text]
Schoen, F. J., Padera, R. F. Jr.
(2003). Cardiac Surgical Pathology. Card Surg Adult
2: 119-185
[Full Text]
Byrne, J. G., Phillips, B. J., Cohn, L. H.
(2003). Reoperative Valve Surgery. Card Surg Adult
2: 1047-1056
[Full Text]
Arya, J., Wolford, H., Harken, A. H.
(2002). Evidence-Based Science: A Worthwhile Mode of Surgical Inquiry. Arch Surg
137: 1301-1303
[Full Text]
Paez, J. M. G., Herrero, E. J., Rocha, A., Martin-Maestro, M., Castillo-Olivares, J. L., Millan, I., Sanmartin, A. C., Cordon, A.
(2002). The Telescoping Suture -Part 1: Does this Technique Improve the Mechanical Behavior of a Biomaterial?: Calf Pericardium. J Biomater Appl
17: 85-103
[Abstract]
Akins, C. W., Hilgenberg, A. D., Vlahakes, G. J., MacGillivray, T. E., Torchiana, D. F., Madsen, J. C.
(2002). Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting. Ann. Thorac. Surg.
74: 1098-1106
[Abstract][Full Text]
Bloomfield, P.
(2002). Choice of heart valve prosthesis. Heart
87: 583-589
[Full Text]
Paez, J. M. G., Carrera, A., Herrero, E. J., Millan, I., Rocha, A., Cordon, A., Sainz, N., Mendez, J., Castillo-Olivares, J. L.
(2001). Influence of the Selection of the Suture Material on the Mechanical Behavior of a Biomaterial to be Employed in the Construction of Implants. Part 2: Porcine Pericardium. J Biomater Appl
16: 68-90
[Abstract]
Stein, P. D., Alpert, J. S., Bussey, H. I., Dalen, J. E., Turpie, A. G.G.
(2001). Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves. Chest
119
: 220S-227S
[Full Text]
Birkmeyer, N. J.O., Birkmeyer, J. D., Tosteson, A. N.A., Grunkemeier, G. L., Marrin, C. A.S., O'Connor, G. T.
(2000). Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis. Ann. Thorac. Surg.
70: 1946-1952
[Abstract][Full Text]
Hammermeister, K., Sethi, G. K., Henderson, W. G., Grover, F. L., Oprian, C., Rahimtoola, S. H.
(2000). Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol
36: 1152-1158
[Abstract][Full Text]
Rosenhek, R., Binder, T., Porenta, G., Lang, I., Christ, G., Schemper, M., Maurer, G., Baumgartner, H.
(2000). Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis. NEJM
343: 611-617
[Abstract][Full Text]
Garcia Paez, J. M., Carrera, A., Cordon, A., Jorge-Herrero, E., Rocha, A., Salvador, J., Mendez, J., Castillo-Olivares, J. L., Millaan, I., Sainz, N.
(2000). Uniaxial and Biaxial Tensile Strength of Calf Pericardium Used in the Construction of Bioprostheses: Biomaterial Selection Criteria. J Biomater Appl
15: 47-64
[Abstract]
Sodian, R., Hoerstrup, S. P., Sperling, J. S., Daebritz, S. H., Martin, D. P., Schoen, F. J., Vacanti, J. P., Mayer, J. E. Jr
(2000). Tissue engineering of heart valves: in vitro experiences. Ann. Thorac. Surg.
70: 140-144
[Abstract][Full Text]
Jamieson, W. E., Germann, E., Fradet, G. J, Lichtenstein, S. V, Miyagishima, R. T, Jamieson, W. E., Germann, E., Fradet, G. J, Lichtenstein, S. V, Miyagishima, R. T
(2000). Bioprostheses and Mechanical Prostheses Predictors of Performance. Asian Cardiovasc. Thorac. Ann.
8: 121-126
[Abstract][Full Text]
Vogt, P. R., Brunner-LaRocca, H.-P., Sidler, P., Zund, G., Truniger, K., Lachat, M., Turina, J., Turina, M. I.
(2000). Reoperative surgery for degenerated aortic bioprostheses: predictors for emergency surgery and reoperative mortality. Eur. J. Cardiothorac. Surg.
17: 134-139
[Abstract][Full Text]
Wheatley, D.J.
(1999). Cardiothoracic surgery in Europe: politics, pressures and practice. Eur. J. Cardiothorac. Surg.
16: 593-601
[Full Text]
Zaidi, A M, Fitzpatrick, A P, Keenan, D J M, Odom, N J, Grotte, G J
(1999). Good outcomes from cardiac surgery in the over 70s. Heart
82: 134-137
[Abstract][Full Text]
Guglielmi, C., Toscano, G., Pistorio, V., Vendramin, I., Bottio, T., Thiene, G., Casarotto, D.
(1999). Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk. Eur. J. Cardiothorac. Surg.
16: 74-80
[Abstract][Full Text]
Peterseim, D. S., Cen, Y.-Y., Cheruvu, S., Landolfo, K., Bashore, T. M., Lowe, J. E., Wolfe, W. G., Glower, D. D.
(1999). LONG-TERM OUTCOME AFTER BIOLOGIC VERSUS MECHANICAL AORTIC VALVE REPLACEMENT IN 841 PATIENTS. J. Thorac. Cardiovasc. Surg.
117: 890-897
[Abstract][Full Text]
Paez, J. M. G., Jorge-Herrero, E.
(1999). Assessment of Pericardium in Cardiac Bioprostheses: A Review. J Biomater Appl
13: 351-388
[Abstract]
Yamak, B., Mavitas, B., Saritas, A., Katircioglu, S F., Ulus, A T., Birincioglu, L., Karagoz, Y H., Sener, E., Tasdemir, O., Bayazit, K.
(1998). Ten-Year Results With Liotta Porcine Bioprostheses in the Mitral Position. Asian Cardiovasc. Thorac. Ann.
6: 260-264
[Abstract][Full Text]
Baker, W. F. JR
(1998). Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I). CLIN APPL THROMB HEMOST
4: 51-75
[Abstract]
Bernal, J. M., Rabasa, J. M., Gutierrez-Garcia, F., Morales, C., Nistal, J. F., Revuelta, J. M.
(1998). The CarboMedics Valve: Experience With 1,049 Implants. Ann. Thorac. Surg.
65: 137-143
[Abstract][Full Text]
Narasimhan, C., Jazayeri, M. R., Sra, J., Dhala, A., Deshpande, S., Biehl, M., Akhtar, M., Blanck, Z.
(1997). Ventricular Tachycardia in Valvular Heart Disease : Facilitation of Sustained Bundle-Branch Reentry by Valve Surgery. Circulation
96: 4307-4313
[Abstract][Full Text]
Chambers, J. C., Somerville, J., Stone, S., Ross, D. N.
(1997). Pulmonary Autograft Procedure for Aortic Valve Disease : Long-term Results of the Pioneer Series. Circulation
96: 2206-2214
[Abstract][Full Text]
Aupart, M. R., Neville, P. H., Hammami, S., Sirinelli, A. L., Meurisse, Y. A., Marchand, M. A.
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113: 492-498
[Abstract][Full Text]
Fann, J. I., Miller, D. C., Moore, KathleenA., Mitchell, R. S., Oyer, P. E., Stinson, E. B., Robbins, R. C., Reitz, B. A., Shumway, N. E.
(1996). Twenty-Year Clinical Experience With Porcine Bioprostheses. Ann. Thorac. Surg.
62: 1301-1311
[Abstract][Full Text]
Vongpatanasin, W., Hillis, L. D., Lange, R. A.
(1996). Prosthetic Heart Valves. NEJM
335: 407-416
[Full Text]
Aupart, M. R., Sirinelli, A. L., Diemont, F. F., Meurisse, Y. A., Dreyfus, X. B., Marchand, M. A.
(1996). The Last Generation of Pericardial Valves in the Aortic Position: Ten-Year Follow-up in 589 Patients. Ann. Thorac. Surg.
61: 615-620
[Abstract][Full Text]
Lytle, B. W., Priest, B. P., Taylor, P. C., Loop, F. D., Sapp, S. K., Stewart, R. W., McCarthy, P. M., Muehrcke, D., Cosgrove, D. M. III
(1996). SURGICAL TREATMENT OF PROSTHETIC VALVE ENDOCARDITIS. J. Thorac. Cardiovasc. Surg.
111: 198-210
[Abstract][Full Text]
Jamieson, W.R. E., Munro, A. I., Burr, L. H., Germann, E., Miyagishima, R. T., Ling, H.
(1995). Influence of Coronary Artery Bypass and Age on Clinical Performance After Aortic and Mitral Valve Replacement With Biological and Mechanical Prostheses. Circulation
92: 101-106
[Abstract][Full Text]
O'Neill, W. W., Chandler, J. G., Gordon, R. E., Bakalyar, D. M., Abolfathi, A. H., Castellani, M. D., Hirsch, J. L., Wieting, D. W., Bassett, J. S., Beatty, K. C., Soltis, M. A., Timmis, G. C., Grines, C. L.
(1995). Radiographic Detection of Strut Separations in Bjork-Shiley Convexo-Concave Mitral Valves. NEJM
333: 414-420
[Abstract][Full Text]
Mohr, F. W., Walther, T., Baryalei, M., Falk, V., Autschbach, R., Scheidt, A., Dalichau, H.
(1995). The Toronto SPV Bioprosthesis: One-Year Results in 100 Patients. Ann. Thorac. Surg.
60: 171-175
[Abstract][Full Text]
Sturzenegger, M., Beer, J. H., Rihs, F.
(1995). Monitoring Combined Antithrombotic Treatments in Patients With Prosthetic Heart Valves Using Transcranial Doppler and Coagulation Markers. Stroke
26: 63-69
[Abstract][Full Text]
Grover, F. L., Cohen, D. J., Oprian, C., Henderson, W. G., Sethi, G., Hammermeister, K. E., Participants in the Department of Veterans Affairs,
(1994). Determinants of the occurrence of and survival from prosthetic valve endocarditisExperience of the Veterans Affairs Cooperative Study on Valvular Heart Disease. J. Thorac. Cardiovasc. Surg.
108: 207-214
[Abstract][Full Text]
Cannegieter, S.C., van der Meer, F.J.M., Briet, E., Rosendaal, F.R., Bussey, H. I., Linn, W. D., Keimowitz, R. M., Fitzgerald, D. J., Turpie, A.G.G., Gent, M., Laupacis, A., Hirsh, J.
(1994). Warfarin and Aspirin after Heart-Valve Replacement. NEJM
330: 507-509
[Full Text]
Bloomfield, P., Wheatley, D. J., Miller, H. C., Hammermeister, K.E., Sethi, G. K.
(1993). Outcomes after Heart-Valve Replacement. NEJM
329: 1278-1278
[Full Text]
Turpie, A., Gent, M., Laupacis, A., Latour, Y., Gunstensen, J., Basile, F., Klimek, M., Hirsh, J.
(1993). A Comparison of Aspirin with Placebo in Patients Treated with Warfarin after Heart-Valve Replacement. NEJM
329: 524-529
[Abstract][Full Text]
Hammermeister, K. E., Sethi, G. K., Henderson, W. G., Oprian, C., Kim, T., Rahimtoola, S., The Veterans Affairs Cooperative Study on Valvular,
(1993). A Comparison of Outcomes in Men 11 Years after Heart-Valve Replacement with a Mechanical Valve or Bioprosthesis. NEJM
328: 1289-1296
[Abstract][Full Text]
Schoen, F.J.
(1992). The first step to understanding valve failure: an overview of pathology. Eur. J. Cardiothorac. Surg.
6: S50-S53
[Abstract]
