CARDIOVASCULAR MEDICINE

Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses

H Oxenham¹, P Bloomfield¹, D J Wheatley^2,*, R J Lee³, J Cunningham¹, R J Prescott³, H C Miller¹

¹ Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
² Department of Cardiac Surgery, Royal Infirmary of Edinburgh
³ Medical Statistics Unit, University of Edinburgh

Correspondence to:
Correspondence to:
Dr Peter Bloomfield, Department of Cardiology, Royal Infirmary, 1 Lauriston Place, Edinburgh EH3 9YW, UK;
peter.bloomfield{at}luht.scot.nhs.uk

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.

Keywords: heart valve; prosthesis; survival

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