Ann Thorac Surg 1980;30:247-258
© 1980 The Society of Thoracic Surgeons
Articles
Considerations in Selection and Management of Patients Undergoing Valve Replacement with Glutaraldehyde-Fixed Porcine Bioprostheses
James B. Williams, M.D.,
Robert B. Karp, M.D.*,
John W. Kirklin, M.D.,
Nicholas T. Kouchoukos, M.D.,
Albert D. Pacifico, M.D.,
George L. Zorn, Jr., M.D.,
Eugene H. Blackstone, M.D.,
Robert N. Brown, B.S.,
Steven Piantadosi, M.D.,
Edwin L. Bradley, Ph.D.
From the Departments of Surgery and Biostatistics, University of Alabama School of Medicine and Medical Center, Birmingham, AL
* Address reprint requests to Dr. Karp, Department of Surgery, University of Alabama Medical Center, University Station, Birmingham, AL 35294
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Abstract
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From November, 1973, through June, 1978, 428 operations in 425 patients were performed for replacement of aortic, mitral, or aortic plus mitral valves, utilizing 277 Hancock and 180 Carpentier-Edwards bioprostheses. Actuarially determined survival at 36 months was similar for all three groups and compared favorably with our experience with the Björk-Shiley prosthesis. Certain patient-related variables influencing late survival were identified by multivariate analysis and included previous operation for congenital heart disease, coronary artery bypass grafting in nonaortic valve replacement, race (black), age at operation, and New York Heart Association Functional Class. A small but definite incidence of thromboembolism occurred in all three groups, again similar to our experience with the Björk-Shiley prosthesis. Multivariate analysis identified four factors influencing risk of thromboembolism: previous cardiac operation, age, double-valve replacement, and rhythm at discharge. Valve degeneration occurred, primarily in children and young adults. Over the medium term, the porcine bioprosthesis compared favorably with mechanical prostheses in terms of survival, function, and thromboembolism. Certain patient-related variables affecting survival may be modified by earlier surgical intervention.
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Footnotes
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Presented at the Sixteenth Annual Meeting of The Society of Thoracic Surgeons, Jan 21–23, 1980, Atlanta, GA.
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References
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- Angell WW, Angell JD, Sywak A. The Angell-Shiley porcine xenograft Ann Thorac Surg 1979;28:537.[Abstract/Free Full Text]
- Berkson J, Gage RP. Calculation of survival risks for cancer Proc Staff Meet Mayo Clin 1950;25:270.[Medline]
- Breslow NE. Covariance analysis of censored survival data Biometrics 1974;30:89.[Medline]
- Cohn LH, Kaster JK, Lee RBB, et al. Long-term follow-up of the Hancock bioprosthetic heart valve: a six-year review Circulation 1979;60(Suppl 1):I-87.
- Conti VR, Bertranou EG, Blackstone EH, et al. Cold cardioplegia versus hypothermia for myocardial protection J Thorac Cardiovasc Surg 1978;76:577.[Abstract]
- Cox DR. Regression models and life tables J R Statis Soc Series B 1972;34:187.
- Davila JC, Magilligan Jr DJ, Lewis Jr JW. Is the Hancock porcine valve the best cardiac valve substitute today? Ann Thorac Surg 1978;26:303.[Abstract/Free Full Text]
- Fairfax AJ, Lambert CD, Leatham A. Systemic embolism in chronic sinoatrial disorder N Engl J Med 1976;295:190.[Medline]
- Geha AS, Laks H, Stansel H, et al. Late failure of porcine valve heterografts in children J Thorac Cardiovasc Surg 1979;78:351.[Abstract]
- Grunkemeier GL, Macmanus Q, Thomas DR, et al. Regression analysis of late survival following mitral valve replacement J Thorac Cardiovasc Surg 1978;75:131.[Medline]
- Kaplan EL, Meier P. Non-parametric estimation from incomplete observations J Am Statis Assoc 1958;53:457.
- Karp RB, Cyrus RJ, Blackstone EH, et al. The Björk-Shiley valve: intermediate term follow-up (abstract) Circulation 1979;59(Suppl 2):II-22160.
- Kirklin JW, Lell WA, Baxley JG, et al. Cardiopulmonary bypass for cardiac surgeryIn: Sabiston DC, Spencer FC, editors. Gibbon's Surgery of the Chest. Third edition. Philadelphia: Saunders; 1976. pp. 846.
- Kutsche LM, Oyer PE, Shumway N, et al. An important complication of Hancock mitral valve replacement in children Circulation 1979;60(Suppl 1):I-98.
- Oyer PE, Stinson EB, Reitz BA, et al. Long-term evaluation of the porcine xenograft bioprosthesis J Thorac Cardiovasc Surg 1979;78:343.[Medline]
- Starr A, Grunkemeier GL, Lambert L, et al. Mitral valve replacement: a ten year follow-up of noncloth-covered vs. cloth-covered caged-ball prostheses Circulation 1976;54(Suppl 3):III-47.
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