TY - JOUR T1 - Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses JF - Heart JO - Heart SP - 715 LP - 721 DO - 10.1136/heart.89.7.715 VL - 89 IS - 7 AU - H Oxenham AU - P Bloomfield AU - D J Wheatley AU - R J Lee AU - J Cunningham AU - R J Prescott AU - H C Miller Y1 - 2003/07/01 UR - http://heart.bmj.com/content/89/7/715.abstract N2 - 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. ER -