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Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses
  1. H Oxenham1,
  2. P Bloomfield1,
  3. D J Wheatley2,*,
  4. R J Lee3,
  5. J Cunningham1,
  6. R J Prescott3,
  7. H C Miller1
  1. 1Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Department of Cardiac Surgery, Royal Infirmary of Edinburgh
  3. 3Medical Statistics Unit, University of Edinburgh
  1. Correspondence to:
    Dr Peter Bloomfield, Department of Cardiology, Royal Infirmary, 1 Lauriston Place, Edinburgh EH3 9YW, UK;
    peter.bloomfield{at}luht.scot.nhs.uk

Abstract

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.

  • heart valve
  • prosthesis
  • survival
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Footnotes

  • * Current address: Department of Cardiac Surgery, Royal Infirmary, Glasgow

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