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Volume 328:1289-1296 May 6, 1993 Number 18 Next

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ABSTRACT

Background Mechanical heart valves are durable but thrombogenic, and their use requires that the patient receive anticoagulants. In contrast, bioprosthetic valves are less thrombogenic, but they have limited durability because of tissue deterioration.

Methods To compare the outcomes of patients who receive these two types of valves, we randomly assigned 575 men scheduled to undergo aortic-valve or mitral-valve replacement to receive either a mechanical or a bioprosthetic valve. The primary end points were death from any cause and any valve-related complication.

Results During an average follow-up of 11 years, there was no difference between the two groups in the probability of death from any cause (11-year probability for mechanical valves, 0.57; for bioprostheses, 0.62; P = 0.57) or in the probability of any valve-related complication (0.65 and 0.69, respectively; P = 0.39). There was a much higher rate of structural valve failure among patients who received bioprosthetic valves (11-year probability, 0.15 for the aortic valves and 0.36 for the mitral valves) than among those who received mechanical valves (no valve failures; P<0.001). However, this difference was offset by a higher rate of bleeding complications among patients with mechanical valves than among those with bioprosthetic valves (11-year probability, 0.42 and 0.26, respectively; P<0.001) and by a greater frequency of periprosthetic valvular regurgitation among patients with mechanical mitral valves than among those with mitral bioprostheses (11-year probability, 0.17 and 0.09, respectively; P = 0.05).

Conclusions After 11 years, the rates of survival and freedom from all valve-related complications were similar for patients who received mechanical heart valves and those who received bioprosthetic heart valves. However, structural failure was observed only with the bioprosthetic valves, whereas bleeding complications were more frequent among patients who received mechanical valves.

Source Information

From the Cardiology Section, Veterans Affairs Medical Center, and the Department of Medicine, University of Colorado School of Medicine, Denver (K.E.H.); the Cardiothoracic Surgery Section, Veterans Affairs Medical Center, and the Department of Surgery, University of Arizona Health Sciences Center, Tucson (G.K.S.); the Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Hines, Ill. (W.G.H., C.O., T.K.); and the Department of Medicine, Section of Cardiology, University of Southern California, Los Angeles (S.R.). The participants in this study are listed in the Appendix.

Address reprint requests to Dr. Hammermeister at the Cardiology Section (111B), Veterans Affairs Medical Center, 1055 Clermont, Denver, CO 80220.

Full Text of this Article

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Outcomes after Heart-Valve Replacement
Bloomfield P., Wheatley D. J., Miller H. C., Hammermeister K.E., Sethi G. K.
Extract | Full Text  
N Engl J Med 1993; 329:1278, Oct 21, 1993. Correspondence

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