Excellent Durability of Starr-Edwards Ball Valves Implanted in the Aortic and Mitral Positions for 27 Years: Report of a Rare Surgical Case

Abstract

A 59-year-old male who had undergone aortic and mitral valve replacement with StarrEdwards ball valves 27 years ago was admitted to our hospital for hemolytic anemia and heart failure. Echocardiography revealed prosthetic valve failure with a high-pressure gradient and small effective orifice area. The Starr-Edwards ball valves were successfully replaced with bileaflet mechanical valves. The explanted valves revealed no structural abnormalities. Keywords: Starr-Edwards ball valve, reoperation CaseA 59-year-old male was admitted to our hospital for prosthetic valve failure; he had a history of rheumatic fever at the age of 10 years and had undergone mitral and aortic valve replacement with Starr-Edwards ball valves (model 6120, 32 mm; model 2400, 24 mm) 27 years ago. Over 20 years postoperatively, he remained asymptomatic; however, in the last 5 years, heart failure and hemolytic anemia due to prosthetic valve dysfunction progressed. He had been presented dyspnea on effort, and cardiomegaly and hemolytic anemia (hemoglobin 8.3 g/dl, lactate dehydrogenase 1004 IU/l, brain natriuretic peptide 333 pg/ml) were noticed by the routine examination (Fig. 1). Echocardiography demonstrated stenosis in the aortic prosthesis with an effective orifice area of 0.5 cm 2 , a peak pressure gradient through the valve of 90 mmHg, and trivial aortic insufficiency. Moderate mitral stenosis with large left atrium without thrombus and moderate tricuspid regurgitation were also evident. Therefore, reoperation was indicated for prosthetic valve failure.Through re-median sternotomy, the chest was reopened without major bleeding. Cardiopulmonary bypass was established with femoral and right axillary artery cannulation and bicaval drainage. Under cardiac arrest, the Starr-Edwards ball valves were excised, and new bileaflet mechanical prostheses were implanted.