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J Thorac Cardiovasc Surg 2004;127:1171-1179
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Mechanical heart valves: Are two leaflets better than one?

^a Medical Data Research, Providence Health System, Portland, Ore, USA
^b Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
^c Cardiac Surgery Unit, University Magna Graecia, Catanzaro, Italy

Received for publication May 8, 2003; revisions received June 16, 2003; accepted for publication August 18, 2003.

^* Address for reprints: YingXing Wu, MD, Medical Data Research, Providence Health System, 9205 SW Barnes Rd #33LL, Portland, OR 97225, USA
yingxing.wu{at}providence.org

OBJECTIVE: We sought to compare the long-term clinical outcomes of patients who underwent isolated aortic valve replacement with single-disc and bileaflet mechanical heart valves.

METHODS: From May 1975 through October 2001, 590 single-disc valves (7 models) were used for isolated valve replacement, and from November 1980 through July 2002, 1283 bileaflet valves (10 models) were used for isolated valve replacement. Detailed follow-up was performed to a maximum of 27.4 and 21.9 years with a total of 6872 and 5811 patient-years for single-disc valves and bileaflet valves, respectively. Survival and valve-related events were analyzed.

RESULTS: Single-disc valves were mainly implanted from 1975 through 1995, whereas bileaflet valves were mainly implanted from 1987 through 2002; thus the years of concurrent use were 1987 through 1995. The bileaflet valve had a significantly lower explantation rate, whereas the single-disc valve had a significantly lower thromboembolism rate. No significant differences were detected in early mortality, long-term survival, and other valve-related complications. When limiting the comparison to the concurrent period of 1987 through 1995, no significant difference was detected in survival or in any valve-related complication.

CONCLUSION: Single-disc and bileaflet valves provide similar clinical performance. The predominant use of bileaflet valves is not based on clinical outcomes.

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