SELECTION OF TISSUE OR PROSTHETIC VALVE - 5-YEAR PROSPECTIVE, RANDOMIZED COMPARISON

  • 1 January 1977
    • journal article
    • research article
    • Vol. 73  (1) , 43-53
Abstract
Patients [99] with isolated primary single valve replacement were randomized to tissue or prosthetic valves in 1970. The Tissue Bank supplied homografts which were either mounted for mitral replacement or used as free grafts for patients with small aortic roots. Starr-Edwards cloth-covered prostheses were used for comparison. There was an even distribution of patients by age, sex, valve lesion and New York Heart Classification attesting to the accuracy of the random selection. Anticoagulants were used in 33 patients who had operative or embolic evidence of atrial clot or else history of thromboembolism. Patients [35] underwent postoperative catheterization. Causes of death and valve failure were presented on an actuarial basis. Death in the Starr-Edwards patient group was sudden or due to fabric wear with subsequent thromboembolism, hemorrhage or infection. The tissue valve was a better choice for valve replacement. While there was no significant functional or hemodynamic apparent difference between the tissue and prosthetic valve, there was improvement in patient morbidity and mortality rate with the use of homografts, particularly in the aortic position. The primary cause of complications in the homograft was tissue deterioration, and this problem was markedly reduced with the advent of glutaraldehyde fixation. No such advance in solving the problem of host incompatability with the prosthesis has been forthcoming.

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