Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses
| Autor: | J Cunningham, Robin J Prescott, David J. Wheatley, R J Lee, P Bloomfield, H Oxenham, H C Miller |
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| Jazyk: | angličtina |
| Rok vydání: | 2003 |
| Předmět: |
Aortic valve
medicine.medical_specialty Interventional cardiology genetic structures business.industry medicine.medical_treatment Mitral valve replacement Cardiovascular Medicine medicine.disease Prosthesis Surgery medicine.anatomical_structure Embolism Aortic valve replacement Internal medicine Mitral valve medicine Cardiology Endocarditis business Cardiology and Cardiovascular Medicine |
| Zdroj: | Bloomfield, P, Oxenham, H, Cunningham, J, Miller, H C, Wheatley, D J, Lee, R J & Prescott, R J 2003, ' Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses ', Heart, vol. 89, no. 7, pp. 715-721 . https://doi.org/10.1136/heart.89.7.715 |
| DOI: | 10.1136/heart.89.7.715 |
| Popis: | OBJECTIVE: To compare survival and outcome in patients receiving a mechanical or bioprosthetic heart valve prosthesis.DESIGN: Randomised prospective trial.SETTING: Tertiary cardiac centre.PATIENTS: Between 1975 and 1979, patients were randomised to receive either a Bjork-Shiley or a porcine prostheses. The mitral valve was replaced in 261 patients, the aortic in 211, and both valves in 61 patients. Follow up now averages 20 years. MAIN OUTCOME MEASURES: Death, reoperation, bleeding, embolism, and endocarditis.RESULTS: After 20 years there was no difference in survival (Bjork-Shiley v porcine prosthesis (mean (SEM)): 25.0 (2.7)% v 22.6 (2.7)%, log rank test p = 0.39). Reoperation for valve failure was undertaken in 91 patients with porcine prostheses and in 22 with Bjork-Shiley prostheses. An analysis combining death and reoperation as end points confirmed that Bjork-Shiley patients had improved survival with the original prosthesis intact (23.5 (2.6)% v 6.7 (1.6)%, log rank test p < 0.0001); this difference became apparent after 8-10 years in patients undergoing mitral valve replacement, and after 12-14 years in those undergoing aortic valve replacement. Major bleeding was more common in Bjork-Shiley patients (40.7 (5.4)% v 27.9 (8.4)% after 20 years, p = 0.008), but there was no significant difference in major embolism or endocarditis.CONCLUSIONS: Survival with an intact valve is better among patients with the Bjork-Shiley spherical tilting disc prosthesis than with a porcine prosthesis but there is an attendant increased risk of bleeding. |
| Databáze: | OpenAIRE |
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