Twenty-year comparison of tissue and mechanical valve replacement

Objective: We sought to compare outcomes with tissue and St Jude Medical me chanical valves over a 20-year period. Methods: Valve-related events and overall survival were analyzed in 2533 pa tients 18 years of age or older undergoing initial aortic, mitral, or combi ned aortic and mitral (double) valve replacement with a tissue valve (Hanco ck, Carpentier-Edwards porcine, or Carpentier-Edwards pericardial) or a St Jude Medical mechanical valve. Total follow-up was 13,390 patient-years. Th ere were 666 St Jude Medical aortic valve replacements, 723 tissue aortic v alve replacements, 513 St Jude Medical mitral valve replacements, 402 tissu e mitral valve replacements, 161 St Jude Medical double valve replacements, and 68 tissue double valve replacements. The mean age was 68 +/- 13.3 year s (St Jude Medical valve, 64.5 +/- 12.9; tissue valve, 72.0 +/- 12.6). Results: There were no overall differences in survival between tissue and m echanical valves. Multivariable analysis indicated that the type of valve d id not affect survival. Analysis by age less than 65 years or 65 years or o lder and presence or absence of coronary disease revealed similar long-term survival in all subgroups. The risk of hemorrhage was lower in patients re ceiving tissue aortic valve replacements but was not significantly differen t in patients receiving mitral valve or double valve replacements. Thromboe mbolism rates were similar for tissue and mechanical valve recipients. Howe ver, reoperation rates were significantly higher in patients receiving both aortic and mitral tissue valves. The reoperation hazard increased progress ively with time both in patients receiving aortic and in those receiving mi tral tissue valves. Overall valve complications were initially higher with mechanical aortic valves but not with mechanical mitral valves. However, va lve complication rates later crossed over, with higher rates in tissue valv e recipients after 7 years in patients undergoing mitral valve replacement and 10 years in those undergoing aortic valve replacement. Conclusions: Tissue and mechanical valve recipients have similar survival o ver 20 years of follow-up. The primary tradeoff is an increased risk of hem orrhage in patients receiving mechanical aortic valve replacements and an i ncreased risk of late reoperation in all patients receiving tissue valve re placements. The risk of tissue valve reoperation increases progressively wi th time.