title: Clinical performance of biological and mechanical prostheses.
abstract: Prosthetic valve replacement remains the most viable alternative for the treatment of severely diseased heart valves. The cumulative experience of mechanical protheses and bioprostheses was evaluated for a 10-year performance comparison: Carpentier-Edwards standard porcine bioprosthesis (CE-S), 1,214 operations; Carpentier-Edwards supraannular porcine bioprosthesis (CE-SAV), 2,489; and mechanical prostheses, 1,364 operations (St. Jude Medical, Carbomedics, Duromedics, and Björk-Shiley Monostrut). The freedom from thromboembolism and hemorrhage at 10 years was 82% for CE-S, 78% for CE-SAV, and 65% for mechanical prostheses (p < 0.05). The relationship existed for major thromboembolism and hemorrhage, 91% (CE-S), 87% (CE-SAV), and 88% (mechanical) (p < 0.05), without clinical relevance. The freedom from structural valve deterioration and valve-related reoperation favored mechanical prostheses (p < 0.05) at 10 years (structural failure: 78% for CE-S, 81% for CE-SAV, and 99% for the mechanical group; reoperation: 74% for CE-S, 76% for CE-SAV, and 88% for mechanical prostheses). The freedom from fatal reoperation was not clinically different: 96% for CE-S, 99% for CE-SAV, and 99% for mechanical prostheses (p < 0.05) at 10 years. The freedom from valve-related mortality was not different (p = not significant) at 10 years: 87% for CE-S; 92% for CE-SAV; and 91% for mechanical. The freedom from permanent impairment or residual morbidity, primarily from thromboembolism, was 95% for CE-S, 92% for CE-SAV, and 95% for mechanical group (p < 0.05) but not clinically relevant.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: G J
authors.initials: GJ
authors.lastname: Fradet
authors.forename: W R
authors.initials: WR
authors.lastname: Jamieson
authors.forename: J G
authors.initials: JG
authors.lastname: Abel
authors.forename: S V
authors.initials: SV
authors.lastname: Lichtenstein
authors.forename: R T
authors.initials: RT
authors.lastname: Miyagishima
authors.forename: H
authors.initials: H
authors.lastname: Ling
authors.forename: G F
authors.initials: GF
authors.lastname: Tyers
mesh_terms: D000206:Actuarial Analysis; D000925:Anticoagulants / Q000009:adverse effects; D001705:Bioprosthesis / Q000009:adverse effects / Q000401:mortality; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology
chemical_list: D000925:Anticoagulants