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J Thorac Cardiovasc Surg 1998;115:577-581
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
From the Julius Center for Patient Oriented Research, Clinical Epidemiology Unit, Utrecht University,a Utrecht, and Department of Cardiothoracic Surgery, the St Antonius Hospital,b Nieuwegein, The Netherlands. Members of The Netherlands Björk-Shiley Study Groupcare listed in the appendix.
Received for publication April 14, 1997; revisions requested June 19, 1997; revisions received July 28, 1997; accepted for publication August 27, 1997. Address for reprints: Marjon Kallewaard, Julius Center for Patient Oriented Research, Utrecht University, PO Box 80035, 3508 TA Utrecht, The Netherlands.
Abstract
Objective: Prophylactic replacement of Björk-Shiley convexo-concave valves (Shiley, Inc., Irvine, Calif.) has been advised for selected groups of patients. If prophylactic replacement is considered, risks of postoperative morbidity and mortality have to be weighed against benefits of replacement. Here we report the results of prophylactic replacement of Björk-Shiley convexo-concave valves at risk of strut fracture in The Netherlands.
Methods: We reviewed medical records of 36 patients undergoing prophylactic replacement of their Björk-Shiley convexo-concave valves before August 1995. Replacement was judged to be prophylactic if the risk of strut fracture outweighed that of death from reoperation, or the patient wished to have the valve replaced although it was not recommended. The procedure was also considered to be prophylactic if a concomitant pathologic condition, not likely to require cardiac surgery in the near future, was present or if preoperative examination revealed an unexpected cardiac pathologic condition.
Results: Twenty-two 70-degree and 16 60-degree Björk-Shiley convexo-concave valves and one spherical valve were replaced (25 aortic and 14 mitral, including three double-valve replacements). Early mortality was 2.8% (1/36) (exact 95% confidence interval [CI] 0.1 to 14.5). Mean follow-up was 33 months. One- and 3-year survivals were 94% (95% CI 79% to 99%) and 91% (95% CI 74% to 97%), respectively. All three deaths were sudden.
Conclusions: If special care is taken in selecting patients, the risk of prophylactic replacement is comparable to that of primary valve replacement. More data are needed to assess whether the risk of sudden death is possibly increased.
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