lock Open Access lock Peer-Reviewed




Comparative study of biological and mechanical prosthesis in mitral and aortic valve replacement

Domingo M Braile; Roberto V Ardito; Marcos Zaiantchick; José L. Verde Santos; Nelson L. K. L Campos; José Luiz B Jacob; Dorotéia R. S Souza; Walter Rade; Maria Inês Martins; Adalberto M Lorga

DOI: 10.1590/S0102-76381988000300001


We studied 1222 patients, who underwent isolated valve replacement; 652 had single mitral (MVR) and 570 single aortic (AVR) replacement. The patients were classified by sex, age and etiology. In the MVR group, the patients received 126 mechanical prostheses, as follow: 49 Björk-Shiley (B-S); 71 Lillehei-Kaster (L-K); 6 Hall-Kaster (H-K) and 526 IMC cardiac prosteses from bovine pericardium (PBIMC). The postoperative follow-up was 95% to 100%. The hospital mortality was 21 % for L-K and 9,5% for PBIMC. The incidence of thrombosis and thromboembolism in events per 100 patients-year was 7.7; 5.6; 6.7 and 1.0 for B-S; L-K; H-K and PBIMC, respectively. The incidence of calcification and tears was 1.8 per 100 patients-years for PBIMC, and did not occur with mechanical prostheses. Only the patients with mechanical prosteses were anticoagulated. In the AVR group, the patients received 336 mechanical prostheses: 92 B-S; 112 L-K; 113 H-K and 234 PBIMC. The postoperative follow-up was 97% to 100%. The hospital mortality was 5.5% for mechanical group, and 2.6% for biological. The incidence of thrombosis and thromboembolism in events per 100 patients-year was 3.0 for B-S; 2.3 for L-K; 2.5 for H-K and 0.3 for PBIMC. Calcification, tear and mechanical failure was 0.54 per 100 patients-year for PBIMC and 0.38 per 100 patients-year for H-K. In the mechanical group, the patients received aspirin and dipiridamole, and 30% of them oral anticoagulants. The authors concluded that the survival, in general manner, isn't related with the type of prosthesis. The incidence of thrombosis and thromboembolism in higher with mechanical valves, and the rate of complications is lower with biological valves. Oral anticoagulation is forceable with mechanical prosthesis in MVR, but unessential in AVR. The bioprosthetic valves don't need anticoagulation. For these reasons, the authors employ by routine, mechanical prostheses for AVR, unless there were counterindications, and biologycal prostheses for MVR.


Foram estudados 1222 pacientes, submetidos a troca valvar simples, sendo 652 mitráis (Mi) e 570 aórticas (Ao). Os pacientes foram classificados por sexo, idade e etiologia. No grupo Mi. receberam 126 próteses mecânicas, como segue: 49 Björk-Shiley (B-S); 71 Lillehei-Kaster (L-K); 6 Hall-Kaster (H-K) e 526 próteses de pericárdio bovino IMC (PBIMC). O seguimento pós-operatório foi de 95% a 100%. A mortalidade hospitalar foi de 21 % para a L-K e 9,5% para a PBIMC. A incidência de trombose e tromboembolismos em eventos por 100% pacientes-ano foi de 7,7; 5,6; 6,7 e 1,0 para: B-S, L-K, H-K e PBIMC, respectivamente. A incidência de calcificação e roturas foi de 1,8 por 100 pacientes-ano para a PBIMC, e náo ocorreu nas próteses mecânicas. Somente os pacientes com próteses mecânicas foram anticoagulados. O grupo Ao totalizou 336 próteses mecânicas (92 B-S, 111 L-K, 133 H-K) e 234 PBIMC. O seguimento pós-operatório foi de 97% a 100%. A mortalidade hospitalar foi de 5,5% para o grupo das mecânicas e 2,6% para o das biológicas. A incidência de trombose e tromboembolismo em eventos por 100 pacientes-ano foi de 3,0 para B-S, 2-3 para L-K, 2,5 para H-K e 0,3 para PBIMC. Calcificação, roturas e falhas mecânicas foram de 0,54 eventos por 100 pacientes-ano para PBIMC e de 0,38 eventos por 100 pacientes-ano para H-K. No grupo mecânico, os pacientes receberam aspirina e dipiridamol e 30% receberam anticoagulante oral. Os autores concluíram que a sobrevida, de um modo geral, não está relacionada ao tipo de prótese empregada. A incidência de trombose e tromboembolismo é mais elevada com válvulas mecânicas, e a taxa de complicações é mais baixa com válvulas biológicas. A anticoagulação oral é obrigatória para as próteses mecânicas na posição Mi, mas não é essencial na posição Ao. As biopróteses não necessitam de anticoagulantes. Por estes motivos, os autores empregam, de rotina, próteses mecânicas para a posição Ao, a menos que existam contra-indicações, e biopróteses para a posição Mi.
Full text available only in portuguese PDF format.


1. AROM, K. V.; NICOLOFF, D. M.; KERSTEN, T. E.; LINDSAY, W. G.; NORTHRUP, W. F. - St. Jude medical prosthesis: valve-related deaths and complications. Ann. Thorac. Surg., 43: 591-598, 1987. [MedLine]

2. BARRAT-BOYES, B. G. - Homograft aortic valve replacement in aortic incompetence and stenosis. Thorax, 19: 131-150, 1964. [MedLine]

3. BEAUDET, R.; POIRIER, N.; BOYLE, D.; NAKHLE, G.; GAUVIN, C. - The Medtronic-Hall cardiac valve: 7,5 years clinical experience. Ann. Thorac. Surg. 42(6): 644-650, 1986. [MedLine]

4. BORKON, A. M.; SOULE, L. M. BAUGHMAN, K. L.; ADUN, H.; BAUNGARTNER, W. A.; GARDNER, T. L.; WATKINS, L.; GOTT, V. L.; REITZ, B. A. - Comparative analysis of mechanical and bioprosthetic valves after aortic valve replacement. J. Thorac. Cardiovasc. Surg., 94(1): 20-33, 1987. [MedLine]

5. BORTOLOTTI, U.; MILANO, A.; THIENE, G.; GUERRA, F.; MAZZUCCO, A.; VALENT, E.; GALLUCCI, V. - Long-term durability of the Hancock porcine bioprosthesis following combined mitral and aortic valve replacement and 11 years experience. Ann. Thorac. Surg., 44(2): 139-144, 1987. [MedLine]

6. BRAILE, D. M. - Prótese valvar de pericárdio bovino modelo IMC: experiência de 8 anos. Rev. SOCESP, 14: 1-3, 1986.

7. BRAILE, D. M.; BILAQUI, A.; ARDITO, R. V.; GRECO, O. T.; GARZON, S. A. C.; NICOLAU, J. C.; JACOB, J. L. B.; AYOUB, J. C. A.; FEDOZZI, N. M.; ANGELONI, M. A.; LORGA, A. M. - Bioprótese cardíaca de pericárdio bovino. Arq. Bras. Cardiol. 39: 247-257, 1982. [MedLine]

8. CLELAND, J.; GLADSTONE, D.; HAMILTON, I.; OKANE, H. - A comparison of the St. Jude Medical and the Carpentier-Edwards xenograft valves in the mitral area. Brit. Heart J., 57(1): 100, 1987.

9. COHN, L. H.; ALRED, E. N. COHN, L. A.; AUSTIN, J. C.; SABIK, J.; DISESA, V. J.; SHEMIN, R. J.; COLLINS, J. J. - Early and late risk of mitral valve replacement, J. Thorac. Cardiovasc. Surg., 90(6): 872-882, 1985.

10. COHN, L. H.; KOSTER, J. L.; MEE, R. B. B.; COLLINS Jr., J. J. - Long-term follow-up of the Hancock bioprosthesis heart valve: a six years review. Circulation, 60(Supl. 1): 87-92, 1979. [MedLine]

11. CZER, L. S.; MATLOFF, A.; CHAUX, A.; DE ROBERTIS, M.; STEWART, M. E.; GREY, R. - The St. Jude valve: analysis of thromboembolism, warfarin - related hemorrhage and survival. Am. Heart. J., 114(2): 389-397, 1987. [MedLine]

12. FONTES, R. D.; POMERANTZEFF, P. M. A.; GRINBERG, M.; SNITCOWSKY, R.; VERGINELLI, G.; ZERBINI, E. J.; JATENE, A. D. - Calcificação de bioprótese de dura-máter: estudo em pacientes jovens. Rev. Paul. Med., 103(5): 235-238, 1985. [MedLine]

13. GALLO, I.; NISTAL, F.; BLASQUES, R.; ARBE, E.; ARTINANO, E. - Incidence of primary tissue valve failure in porcine bioprosthetic heart valves. Ann. Thorac. Surg. 45(1): 66-70, 1988. [MedLine]

14. GALLO, I.; NISTAL, F.; REVUELTA, J. M.; GARCI-SATUE, E.; ARTINANO, E.; DURAN, C. G. - Incidence of primary tissue valve failure with the lonescu-Shiley pericardial valve. J. Thorac. Cardiovasc. Surg., 90(2): 278-280, 1985. [MedLine]

15. HAMMOND, G. L.; GEHA, A. S.; KOPT, G. S.; HASHIM, S. W. - Biological versus mechanical valves: analysis of 116 valves inserted in 1012 adult patients with a 4818 patient-years follow-up. J. Thorac. Cardiovasc. Surg., 93(2): 182-198, 1987. [MedLine]

16. HARKEN, D. E.; SOROFF, H. S.; TAYLOR, W. J. - Partial and complete prostheses in aortic insuficiency. J. Thorac. Cardiovasc. Surg., 40(6): 744-762, 1960.

17. HARTZ, R. S.; FISHER, E. B.; FINKELMEIER, B. - An light-year experience with porcine bioprosthetic cardiac valves. J. Thorac. Cardiovasc. Surg., 91(6): 910-917, 1986. [MedLine]

18. HUSEBYE, D. G.; PLUTH, J. R.; PIEHLER, J. M.; SCHAFF, H. V.; ORSZULAK, T. A.; PUGA, F. J.; DANIELSON, G. K. - Reoperation on prosthetic heart valves. J. Thorac Cardiovasc. Surg., 86(4): 543-552, 1983. [MedLine]

19. IONESCU, M. I.; TANDON, A. P.; CHIDAMBARAM, M.; YAKIREVICH, V. S.; SILVERTON, M. P. - Durability of the pericardial valve. Eur. Heart. J., 85(Supl. D): 101-106, 1984.

20. IONESCU, M. I.; TANDON, A. P.; MARY, D. A. S.; ABID, A. - Heart valve replacement with the Ionescu-Shiley pericardial xenograft. J. Thorac. Cardiovasc. Surg., 73(1): 31-42, 1977. [MedLine]

21. LAWFORD, P. V.; ROBERTS, R.; DRURY, P. J.; BLACK, M. M. - Valve failure; a pathological and physical study of explanted bioprosthetic valves. Life Support Syst., 4(Supl. 2): 151-153, 1986.

22. MAGILLIGAN Jr, D. J.; LEWS Jr, J. W.; TILLEY, B.; PETERSON, E. - The porcine bioprosthetic valve: twelve years later. J. Thorac. Cardiovas. Surg., 89(4): 499-507, 1985.

23. MAKHLOUF, A. E.; FRIELLI, B.; OBERHANSCI, I.; ROUGE, J. C.; FAIDUTTI, B. - Prosthetic heart valve replacement in children. J. Thorac. Cardiovasc. Surg., 93(1): 80-85, 1987. [MedLine]

24. ARTINELLI, J.; FRAILE, J.; ARTIZ, V.; MORENO, J.; RABAGO, G. - Long-term comparative analysis of the Björk-Shiley and Hancock valves implanted in 1975. J. Thorac. Cardiovasc. Surg., 90(5): 741-749, 1985. [MedLine]

25. MILLER, H. C.; BLOOMFIELD, P.; KITCHIN, A. H.; WHEATLEY, D. J.; WALBAUM, P. R.; LUTZ, W. - Evaluation of three heart valve prostheses. Cardiol. Board Rev., 4(1): 25-43, 1987.

26. NARDUCCI, C.; RUSSO, L.; GIANNELLA, S.; CHIANTERA, A.; ALESSANDRO, L. C. - Identification of dysfunction patterns of cardiac bioprosthesis. Life Support Syst, 4(2): 124-126, 1986.

27. NASHEF, S. A. M.; SETHIA, B.; TURNER, M. A.; DAVIDSON, K. G.; LEWIS, S.; BAIN, W. H. - Bjork-Shiley and Carpentier-Edwards valves. J. Thorac. Cardiovasc. Surg, 93(3): 394-404, 1987. [MedLine]

28. OLESEN, K. H.; RYGG, I. H.; WENNEVOLD, A.; NYBOE, J. - Long-term follow-up in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis: overall results and prosthesis related complications. Eur. Heart J., 7(9): 808-816, 1986. [MedLine]

29. OLESEN, K. H.; RYGG, I. H.; WENNEVOLD, A.; NYBOE, J. - Long-term follow-up in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis: overall results and prosthesis related complications. Eur. Heart. J., 8(7): 680-688, 1987. [MedLine]

30. OTT, D. A.; COELHO, A. T.; COOLEY, D. A.; REUL Jr, G. J. - Ionescu-Shiley pericardial xenograft valve: hemodinamic evaluation and early clinical follow-up of 326 patients. Cardiovasc. Dis., 7(1): 137-149, 1980.

31. OTT, D. A.; COOLEY, D. A.: REUL, Jr., G. J.; DUNCAN, J. M.; FRAZIER, O. H.; LIVESAN, J. J. - Ionescu-Shiley bovine pericardial bioprostheses. Cardiol. Clin., 3(4): 343-369, 1985.

32. OYER, P. E., STINSON, E. B.; RETZ, B. A.; MILLER, D. C.; ROSSITER, S. J.; SHUMWAY, N. E. - Long-term evaluation of the porcine xenograft bioprosthesis. J. Thorac. Cardiovasc. Surg., 78(3): 343-350, 1979. [MedLine]

33. PLUTH, J. R. - The Starr-Edwards mitral valve. In: IONESCU, M. I. & COHN, L. H. Mitral valve disease. Boston. Butterworth & Co, 1985. p.217-220.

34. REUL Jr., G. J.; COOLEY, D. A.; DUNCAN, J. M.; FRAZIER, O. H.; HALLMAN, G. L.; LIVESAY, J. J.; OTT, D. A.; WALKER, W. E. - Valve failure with the Ionescu-Shiley bovine pericardial bioprostheses: analysis of 2680 patients. J. Vasc. Surg., 2(1): 192-204, 1985. [MedLine]

35. ROSS, D. N. - Homograft replacement of the aortic valve. Lancet, 2: 487, 1962. [MedLine]

36. SCHOEN, F. J. - Cardiac valve prostheses: pathological and bioengineering consideration. J. Cardiovasc. Surg., 2(1): 65-108, 1987.

37. SCHOEN, F. J.; FERNANDEZ, J.; GONZALES-LAVIN, L.; CEARNAIANU, A. - Causes of failure and pathologic findings in surgically removed Ionescu-Shiley standard bovine pericardial heart valve bioprostheses: emphasis on progressive structural deterioration. Circulation, 76(3): 618-627, 1987. [MedLine]

38. SCHOEN, F. J.; KUJOWICH, J. L.; WEBB, C. L.; LEVY, R. J. - Chemically determined mineral content of explantd porcine aortic valve bioprostheses: correlation with radiographic assessment of calcification and clinical data. Circulation, 76(5): 1061-1066, 1987. [MedLine]

39. SCHOEN, F. J.; TSAO, J. W.; LEVY, R. J. - Calcification of bovine pericardium used in cardiac valve bioprostheses. Ann. J. Pathol., 123(1): 134-145, 1986.

40. SETHIA, B.; TURNER, M. A.; LEWIS, S.; RODGER, R. A.; BAIN, W. H.; KOUCHOWKOS, N. T. - Fourteen years experiénce with the Björk-Shiley tilting disc prosthesis. J. Thorac. Cardiovasc. Surg., 91(3): 350-361, 1986. [MedLine]

41. STARNES, V. A. & MILLER, D. C. - Selecting a prosthetic valve. In: FORTUIN, N.J. Current therapy in cardiovascular disease. Philadelphia, B. C. Decker Inc., 1987. p.77-79.

42. STARR, A. & EDWARDS, M. L. - Mitral replacement: clinical experience with a ball-valve prosthesis. Ann. Surg., 154(8): 726-731, 1961.

43. WALKER, W. E.; DUNCAN, J. M.; FRAZIER Jr., O. H.; LIVESAY, J. J.; OTT, D. A.; REUL, G. J.; COOLEY, D. A. - Early experience with the lonescu-Shiley pericardial xenograft valve. J. Thorac Cardiovasc. Surg., 86(4): 570-575, 1983. [MedLine]

CCBY All scientific articles published at are licensed under a Creative Commons license


All rights reserved 2017 / © 2021 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY