HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hammermeister, K. Articles by Rahimtoola, S. H. Search for Related Content PubMed PubMed Citation Articles by Hammermeister, K. Articles by Rahimtoola, S. H.

CLINICAL STUDY: CARDIAC SURGERY

Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial

Karl Hammermeister, MD, FACC^*, Gulshan K. Sethi, MD, FACC, William G. Henderson, PhD, Frederick L. Grover, MD, FACC^*, Charles Oprian, PhD and Shahbudin H. Rahimtoola, MB, FRCP, MACP, MACC

^* Denver VA Medical Center and University of Colorado Health Sciences Center, Denver, Colorado, USA
Tucson VA Medical Center and University of Arizona Health Sciences Center, Tucson, Arizona, USA
Hines VA Medical Center, Hines, Illinois, USA
LAC and USC Medical Center, University of Southern California, Los Angeles, California, USA

Manuscript received December 28, 1999; revised manuscript received April 4, 2000, accepted May 4, 2000.

Reprint requests and correspondence: William G. Henderson, VA Cooperative Studies Program Coordinating Center (151K), P. O. Box 5000, Hines VA Hospital, Hines, Illinois 60141-5151

OBJECTIVES

The goal of this study was to compare long-term survival and valve-related complications between bioprosthetic and mechanical heart valves.

BACKGROUND

Different heart valves may have different patient outcomes.

METHODS

Five hundred seventy-five patients undergoing single aortic valve replacement (AVR) or mitral valve replacement (MVR) at 13 VA medical centers were randomized to receive a bioprosthetic or mechanical valve.

RESULTS

By survival analysis at 15 years, all-cause mortality after AVR was lower with the mechanical valve versus bioprosthesis (66% vs. 79%, p = 0.02) but not after MVR. Primary valve failure occurred mainly in patients <65 years of age (bioprosthesis vs. mechanical, 26% vs. 0%, p < 0.001 for AVR and 44% vs. 4%, p = 0.0001 for MVR), and in patients 65 years after AVR, primary valve failure in bioprosthesis versus mechanical valve was 9 ± 6% versus 0%, p = 0.16. Reoperation was significantly higher for bioprosthetic AVR (p = 0.004). Bleeding occurred more frequently in patients with mechanical valve. There were no statistically significant differences for other complications, including thromboembolism and all valve-related complications between the two randomized groups.

CONCLUSIONS

At 15 years, patients undergoing AVR had a better survival with a mechanical valve than with a bioprosthetic valve, largely because primary valve failure was virtually absent with mechanical valve. Primary valve failure was greater with bioprosthesis, both for AVR and MVR, and occurred at a much higher rate in those aged <65 years; in those aged 65 years, primary valve failure after AVR was not significantly different between bioprosthesis and mechanical valve. Reoperation was more common for AVR with bioprosthesis. Thromboembolism rates were similar in the two valve prostheses, but bleeding was more common with a mechanical valve.

Abbreviations and Acronyms   AVR = aortic valve replacement   MVR = mitral valve replacement   VA = Veterans Affairs

This article has been cited by other articles:

				E B Schelbert, M S Vaughan-Sarrazin, K F Welke, and G E Rosenthal Valve type and long-term outcomes after aortic valve replacement in older patients Heart, September 1, 2008; 94(9): 1181 - 1188. [Abstract] [Full Text] [PDF]

				G. W. Fischer and D. H. Adams Real-time three-dimensional TEE-guided repair of a paravalvular leak after mitral valve replacement Eur J Echocardiogr, July 24, 2008; (2008) jen203v1. [Abstract] [Full Text] [PDF]

				J. L. Thompson, T. M. Sundt, M. E. Sarano, P. J. Santrach, and H. V. Schaff In-patient international normalized ratio self-testing instruction after mechanical heart valve implantation. Ann. Thorac. Surg., June 1, 2008; 85(6): 2046 - 2050. [Abstract] [Full Text] [PDF]

				M. L. Brown, H. V. Schaff, B. D. Lahr, C. J. Mullany, T. M. Sundt, J. A. Dearani, C. G. McGregor, and T. A. Orszulak Aortic valve replacement in patients aged 50 to 70 years: Improved outcome with mechanical versus biologic prostheses. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 878 - 884. [Abstract] [Full Text] [PDF]

				C. de Vincentiis, A. B. Kunkl, S. Trimarchi, P. Gagliardotto, A. Frigiola, L. Menicanti, and M. Di Donato Aortic Valve Replacement in Octogenarians: Is Biologic Valve the Unique Solution? Ann. Thorac. Surg., April 1, 2008; 85(4): 1296 - 1301. [Abstract] [Full Text] [PDF]

				A. Russo, F. Grigioni, J.-F. Avierinos, W. K. Freeman, R. Suri, H. Michelena, R. Brown, T. M. Sundt, and M. Enriquez-Sarano Thromboembolic Complications After Surgical Correction of Mitral Regurgitation: Incidence, Predictors, and Clinical Implications J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1203 - 1211. [Abstract] [Full Text] [PDF]

				T. Eitz, S. Schenk, D. Fritzsche, A. Bairaktaris, O. Wagner, H. Koertke, and R. Koerfer International Normalized Ratio Self-Management Lowers the Risk of Thromboembolic Events After Prosthetic Heart Valve Replacement Ann. Thorac. Surg., March 1, 2008; 85(3): 949 - 955. [Abstract] [Full Text] [PDF]

				J. A.C. Ennker, A. A. Albert, U. P. Rosendahl, I. C. Ennker, F. Dalladaku, and I. Florath Ten-Year Experience With Stentless Aortic Valves: Full-Root Versus Subcoronary Implantation Ann. Thorac. Surg., February 1, 2008; 85(2): 445 - 453. [Abstract] [Full Text] [PDF]

				W. Flameng, B. Meuris, G. De Visscher, C. Cunanan, E. Lane, E. Verbeken, P. Herijgers, and M.-C. Herregods Trilogy Pericardial Valve: Hemodynamic Performance and Calcification in Adolescent Sheep Ann. Thorac. Surg., February 1, 2008; 85(2): 587 - 592. [Abstract] [Full Text] [PDF]

				R. El Oakley, P. Kleine, and D. S. Bach Choice of Prosthetic Heart Valve in Today's Practice Circulation, January 15, 2008; 117(2): 253 - 256. [Full Text] [PDF]

				R. F. Padera Jr. and F. J. Schoen Pathology of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 111 - 178. [Full Text]

				M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]

				N. D. Desai and G. T. Christakis Bioprosthetic Aortic Valve Replacement: Stented Pericardial and Porcine Valves Card. Surg. Adult, January 1, 2008; 3(2008): 857 - 894. [Full Text]

				T. E. David Surgical Treatment of Aortic Valve Endocarditis Card. Surg. Adult, January 1, 2008; 3(2008): 949 - 956. [Full Text]

				T. Gudbjartsson, T. Absi, and S. Aranki Mitral Valve Replacement Card. Surg. Adult, January 1, 2008; 3(2008): 1031 - 1068. [Full Text]

				J. E. Mayer Tissue Engineering for Cardiac Valve Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 1649 - 1656. [Full Text]

				J. Dunning, R.J. Graham, J. Thambyrajah, M.J. Stewart, S.W.H. Kendall, and S. Hunter Stentless vs. stented aortic valve bioprostheses: a prospective randomized controlled trial Eur. Heart J., October 1, 2007; 28(19): 2369 - 2374. [Abstract] [Full Text] [PDF]

				M. Ruel, V. Chan, P. Bedard, A. Kulik, L. Ressler, B. K. Lam, F. D. Rubens, W. Goldstein, P. J. Hendry, R. G. Masters, et al. Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age Circulation, September 11, 2007; 116(11_suppl): I-294 - I-300. [Abstract] [Full Text] [PDF]

				B. Kunadian, K. Vijayalakshmi, A. R. Thornley, M. A. de Belder, S. Hunter, S. Kendall, R. Graham, M. Stewart, J. Thambyrajah, and J. Dunning Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic Valves Ann. Thorac. Surg., July 1, 2007; 84(1): 73 - 78. [Abstract] [Full Text] [PDF]

				K. Prasongsukarn, W. E. Jamieson, E. Germann, F. Chan, and S. V Lichtenstein Aortic and Mitral Prosthetic Valve Replacement in Age Groups 61 65 & 66 70 Years Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 127 - 133. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]

				L. Lau, W.R. E. Jamieson, C. Hughes, E. Germann, and F. Chan What Prosthesis Should Be Used at Valve Re-Replacement After Structural Valve Deterioration of a Bioprosthesis? Ann. Thorac. Surg., December 1, 2006; 82(6): 2123 - 2132. [Abstract] [Full Text] [PDF]

				G. L. Grunkemeier, R. Jin, and A. Starr Prosthetic heart valves: objective performance criteria versus randomized clinical trial. Ann. Thorac. Surg., September 1, 2006; 82(3): 776 - 780. [Abstract] [Full Text] [PDF]

				G. Rizzoli, S. Mirone, P. Ius, E. Polesel, T. Bottio, L. Salvador, C. Zussa, G. Gerosa, and C. Valfre Fifteen-year results with the Hancock II valve: A multicenter experience. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 602 - 609.e4. [Abstract] [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]

				O. Lund and M. Bland Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacement J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 20 - 26. [Abstract] [Full Text] [PDF]

				R. Sodian, C. Lueders, L. Kraemer, W. Kuebler, M. Shakibaei, B. Reichart, S. Daebritz, and R. Hetzer Tissue Engineering of Autologous Human Heart Valves Using Cryopreserved Vascular Umbilical Cord Cells Ann. Thorac. Surg., June 1, 2006; 81(6): 2207 - 2216. [Abstract] [Full Text] [PDF]

				V. Chan, W.R.E. Jamieson, E. Germann, F. Chan, R.T. Miyagishima, L.H. Burr, M.T. Janusz, H. Ling, and G.J. Fradet Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1267 - 1273. [Abstract] [Full Text] [PDF]

				Additional Information JAMA, March 15, 2006; 295(11): E1 - E6. [Full Text] [PDF]

				Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration of allograft and pericardial prostheses. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 558 - 564.e4.

				S. H. Rahimtoola The Year in Valvular Heart Disease J. Am. Coll. Cardiol., January 17, 2006; 47(2): 427 - 439. [Full Text] [PDF]

				U. Ozyurda, A. R. Akar, O. Uymaz, M. Oguz, M. Ozkan, C. Yildirim, A. Aslan, and R. Tasoz Early clinical experience with the On-X prosthetic heart valve Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 588 - 594. [Abstract] [Full Text] [PDF]

				C. E. Ruiz, M. Iemura, S. Medie, P. Varga, W. G. Van Alstine, S. Mack, A. Deligio, N. Fearnot, U. H. Beier, D. Pavcnik, et al. Transcatheter placement of a low-profile biodegradable pulmonary valve made of small intestinal submucosa: A long-term study in a swine model J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 477 - 484. [Abstract] [Full Text] [PDF]

				I Florath, A Albert, U Rosendahl, T Alexander, I C Ennker, and J Ennker Mid term outcome and quality of life after aortic valve replacement in elderly people: mechanical versus stentless biological valves Heart, August 1, 2005; 91(8): 1023 - 1029. [Abstract] [Full Text] [PDF]

				R. V. Freeman and C. M. Otto Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies Circulation, June 21, 2005; 111(24): 3316 - 3326. [Full Text] [PDF]

				W.R.E. Jamieson, O. von Lipinski, R.T. Miyagishima, L.H. Burr, M.T. Janusz, H. Ling, G.J. Fradet, F. Chan, and E. Germann Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after mitral valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1301 - 1308. [Abstract] [Full Text] [PDF]

				D. Wheatley and M. Will Mitral valve replacement with mechanical or bioprosthetic valve MMCTS, April 25, 2005; 2005(0425): 1024. [Abstract] [Full Text] [PDF]

				P. Gjertsson, K. Caidahl, M. Farasati, A. Oden, and O. Bech-Hanssen Preoperative moderate to severe diastolic dysfunction: A novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 890 - 896. [Abstract] [Full Text] [PDF]

				F. J. Schoen and R. J. Levy Calcification of Tissue Heart Valve Substitutes: Progress Toward Understanding and Prevention Ann. Thorac. Surg., March 1, 2005; 79(3): 1072 - 1080. [Abstract] [Full Text] [PDF]

				D. D. Potter, T. M. Sundt III, K. J. Zehr, J. A. Dearani, R. C. Daly, C. J. Mullany, C. G.A. McGregor, F. J. Puga, H. V. Schaff, and T. A. Orszulak Operative risk of reoperative aortic valve replacement J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 94 - 103. [Abstract] [Full Text] [PDF]

				A. A. Mangi and D. F. Torchiana A technique for repair of mitral paravalvular leak J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 771 - 772. [Full Text] [PDF]

				J P A Puvimanasinghe, J J M Takkenberg, M B Edwards, M J C Eijkemans, E W Steyerberg, L A van Herwerden, K M Taylor, G L Grunkemeier, J D F Habbema, and A J J C Bogers Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation Heart, October 1, 2004; 90(10): 1172 - 1178. [Abstract] [Full Text] [PDF]

				S. Rahimtoola Reply J. Am. Coll. Cardiol., August 4, 2004; 44(3): 667 - 668. [Full Text] [PDF]

				A. Sedrakyan, P. Hebert, V. Vaccarino, A. D. Paltiel, J. A. Elefteriades, J. Mattera, Z. Lin, S. A. Roumanis, and H. M. Krumholz Quality of life after aortic valve replacement with tissue and mechanical implants J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 266 - 272. [Abstract] [Full Text] [PDF]

				J. T. Butcher, A. M. Penrod, A. J. Garcia, and R. M. Nerem Unique Morphology and Focal Adhesion Development of Valvular Endothelial Cells in Static and Fluid Flow Environments Arterioscler. Thromb. Vasc. Biol., August 1, 2004; 24(8): 1429 - 1434. [Abstract] [Full Text] [PDF]

				J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF]

				B. Iung, J. Rousseau-Paziaud, B. Cormier, E. Garbarz, O. Fondard, E. Brochet, C. Acar, J.-P. Couetil, U. Hvass, and A. Vahanian Contemporary results of mitral valve repair for infective endocarditis J. Am. Coll. Cardiol., February 4, 2004; 43(3): 386 - 392. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola The year in valvular heart disease J. Am. Coll. Cardiol., February 4, 2004; 43(3): 491 - 504. [Full Text] [PDF]

				D. S. Bach Choice of prosthetic heart valves:update for the next generation J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1717 - 1719. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola The next generation of prosthetic heart valves needs a proven track record of patient outcomes at >=15 to 20 years J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1720 - 1721. [Abstract] [Full Text] [PDF]

				G. Nollert, J. Miksch, E. Kreuzer, and B. Reichart Risk factors for atherosclerosis and the degeneration of pericardial valves after aortic valve replacement J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 965 - 968. [Abstract] [Full Text] [PDF]

				B. Iung, G. Baron, E. G. Butchart, F. Delahaye, C. Gohlke-Barwolf, O. W. Levang, P. Tornos, J.-L. Vanoverschelde, F. Vermeer, E. Boersma, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease Eur. Heart J., July 1, 2003; 24(13): 1231 - 1243. [Abstract] [Full Text] [PDF]

				H Oxenham, P Bloomfield, D J Wheatley, R J Lee, J Cunningham, R J Prescott, and H C Miller Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses Heart, July 1, 2003; 89(7): 715 - 721. [Abstract] [Full Text] [PDF]

				A. Moneta, E. Villa, and F. Donatelli An alternative technique for non-infective paraprosthetic leakage repair Eur. J. Cardiothorac. Surg., June 1, 2003; 23(6): 1074 - 1075. [Abstract] [Full Text] [PDF]

				G Hanania Which heart valve prosthesis for patients aged between 60 and 70 years? Heart, May 1, 2003; 89(5): 481 - 482. [Full Text] [PDF]

				S. H. Rahimtoola Choice of prosthetic heart valve for adult patients J. Am. Coll. Cardiol., March 19, 2003; 41(6): 893 - 904. [Abstract] [Full Text] [PDF]

				M. Doss, S. Martens, J.P. Wood, T. Aybek, P. Kleine, G. Wimmer Greinecker, and A. Moritz Performance of stentless versus stented aortic valve bioprostheses in the elderly patient: a prospective randomized trial Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 299 - 304. [Abstract] [Full Text] [PDF]

F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]