BIOLOGICAL VERSUS MECHANICAL VALVES - ANALYSIS OF 1,116 VALVES INSERTED IN 1,012 ADULT PATIENTS WITH A 4,818 PATIENT-YEAR AND A 5,327 VALVE-YEAR FOLLOW-UP

  • 1 February 1987
    • journal article
    • research article
    • Vol. 93  (2) , 182-198
Abstract
All surviving patients between 18 and 88 years of age receiving biological or mechanical prosthetic heart valves at the Yale-New Haven Hospital from January 1974 through January 1985 were analyzed for thromboembolism, anticoagulation-related hemorrhage, endocarditis, perivalvular leak, value failure, need for reoperation, late cardiac death, and valve-related death. The rates of these events were analyzed in linear and actuarial terms over the 11 year period. A total of 533 patients received 606 biological valves (328 aortic, 252 mitral, 24 tricuspid, and two pulmonary, consisting of 482 Carpentier-Edwards, 108 Hancock, 15 Ionescu-Shiley, and one other), with a mean follow-up of 2,571 patient-years and 2,935 valve-years. They were compared with 479 patients with 510 mechanical valves (330 aortic, 175 mitral, and five tricuspid, consisting of 178 Starr-Edwards, 166 St. Jude Medical, 164 Bjork-Shiley, and two others), which were implanted for 2,247 patient-years and 2,392 valve-years. We found a significantly increased incidence of thromboembolism (p < 0.001) and reoperation for perivalvular leak (p < 0.05) in the mechanical valves compared with biological valves, but a significantly increased rate of valve failure (p < 0.001) in the biological valves compared with the mechanical valves. The overall analysis comparing total morbidity and valve-related mortality signifiantly (p < 0.01) favored the biological valves in the first 5 years of the study and the mechanical valves (p < 0.001) in the second 5 years of the study. However, the net 10 year results showed no significant difference between the two types of valves. In summary, we found little direct evidence to strongly support the generalized use of one type of valve over another.

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