Complications due to cloth wear in cloth-covered Starr-Edwards aortic and mitral valve prostheses—and their management

Shah, Anilkumar; Dolgin, Martin; Tice, David A.; Trehan, Naresh

doi:10.1016/0002-8703(78)90054-6

Cited by 32 publications

(9 citation statements)

References 19 publications

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“…However, some defects due to the design of the valve such as unacceptable transvalvular gradient in smaller sizes, absence of central flow causing higher transvalvular gradients especially in aortic position and thromboembolic complications associated with the strut clothes had never been solved (2). The incidence of complications related to the Starr-Edwards valve, especially thromboembolism was higher compared with the bileaflet valves (3)(4)(5). Regarding these data, even in cases with functioning valves surgeons were tended to replace it with updated versions (6).…”

Section: Discussionmentioning

confidence: 99%

“…Several centers published their experiences with this valve in both aortic and mitral positions. Encountered complications with caged ball valve such as; systemic embolisation, ball variance, high pressure gradient, growth of pannus and chronic hemolysis; lead to new valve designs (2)(3)(4)(5). Nowadays these investigations still goes on for perfect valve.…”

Section: Introductionmentioning

confidence: 99%

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Starr-Edwards caged ball valve pursuing to astonish us-38 years in mitral position

Gokaslan¹,

Eren²

2012

Anadolu Kardiyol Derg

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Starr-Edwards caged ball valve pursuing to astonish us-38 years in mitral position

Gokaslan¹,

Eren²

2012

Anadolu Kardiyol Derg

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“…Shah et al have indicated the following findings suggesting cloth wear: (1) transient cerebral ischemia attacks or infarction of the systemic organs despite appropriate anticoagulant therapy; (2) arterial embolism more than 4 years after valve replacement; (3) increased metal click sounds; (4) persistent severe hemolytic anemia; and (5) abnormalities in the positional relationship between the ball and the valve location at valve opening/closing under fluoroscopy, or regurgitation of contrast medium from the valve orifice. 9 They concluded that the diagnosis of cloth wear is impossible before reoperation and it was made by exclusion of other causes of recurrent transient cerebral ischemic attacks or systemic emboli and by exclusion of other causes of hemolytic anemia. Aggressive management of complications of cloth wear by reoperation is likely to prevent disabling or lethal consequences.…”

Section: Discussionmentioning

confidence: 99%

Valve Dysfunction of the Cloth-Covered Starr-Edwards Ball Valve

Shiono

Sezai

Hata

et al. 2005

Circ J

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ince the first successful valve replacement using the original Starr-Edwards (S-E) caged silastic ball valve, some engineering modifications were made to enhance hemodynamic performance and fixation. The fabric covering was extended to the inflow orifice and then to the cage, and a silastic ball was changed to a stellite ball, which resulted in a group of "cloth-covered S-E ball valves". 1,2 Between June 1968 and March 1977, the clothcovered ball valves were used for aortic and mitral valve replacement (MVR) on a routine basis. Long-term results with the S-E ball valves have been reported showing satisfactory results with reliable durability and safety; they could represent the standard in mechanical valve replacement until recent prostheses can show a significant improvement in long-term results. However, reoperation after valve replacement with the S-E ball valve is unavoidable, and there have been only a few articles reporting detailed data concerning reoperations for the cloth-covered model of the S-E ball valve. The present study reports valve dysfunction and reoperation for the cloth-covered S-E ball prostheses. Methods PatientsThe cloth-covered S-E ball valves (aortic model 2300, 2310, 2320, and 2400, and mitral model 6300, 6310, 6320, and 6400) were implanted in the aortic and/or mitral position as the first choice for prosthetic substitution at our institution between June 1968 and March 1977. Oral anticoagulation regimens were administered after surgery and left at our outpatient clinic or local general practitioner's clinic. Among the 66 operative survivors who underwent an isolated aortic valve replacement (AVR; n=14) or MVR (n=52), 20 patients (11 male and 9 female) required reoperation 22 times because of valve dysfunction, thromboembolic complication, paravalvular leakage, hemolytic anemia, and/or prosthetic valve endocarditis. Reoperation was carried out at a mean of 15.9±9.8 years (range, 2.3 to 34.2 years) after initial valve replacement. The S-E valves were re-implanted 8 times in the aortic position (n=7; group A) and 14 times in the mitral position (n=13; group M) at a mean age of 44.7±13.9 years (range, 14 to 66 years). The S-E valves used at the initial operations and indications for reoperation are listed in Table 1. At reoperation, the heart was completely mobilized through a repeat median sternotomy and cardiopulmonary bypass was implemented through the femoral artery or the aorta for arterial perfusion, and right atrium for venous drainage. The patient's systemic temperature was cooled to 32°C and the heart was arrested using St Thomas' cold crystalloid cardioplegic solution. Care was taken during the prosthesis excision not to remove any structures from the prosthetic surfaces to avoid artificial changes on the prosthesis. The prosthetic valve was replaced using an interrupted method with braided polyester sutures or pledgeted polyester sutures at the supra-annular position.Excised valves were carefully examined, and morbidity after the initial and subsequent operations was defined

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“…A recurrent cnncism of the Starr-Edwards clothcovered steel valve prosthesis has been the increased frequency of hemolysis and cloth wear [1][2][3][4]. The incidence of clinically significant cloth wear is small.…”

Section: Discussionmentioning

confidence: 99%

Severe Hemolysis Due to Cloth Wear 23 Years after Aortic Valve Replacement on a Starr—Edwards Ball Valve Model 2320

Murakami

Tanaka

Watanabe

et al. 2002

Cardiovascular Surgery

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Despite iron substitution therapy, a patient developed severe hemolytic anemia 23 yr after insertion of a cloth-covered Starr—Edwards model 2320 aortic valve prosthesis. The prosthesis showed no sign of significant dysfunction. Upon removal, it showed extensive cloth wear on the inner surface of all three struts; one strut was completely denuded of its cloth covering. Hemolysis immediately resolved after replacement with a St Jude aortic prosthesis.

show abstract

Complications due to cloth wear in cloth-covered Starr-Edwards aortic and mitral valve prostheses—and their management

Cited by 32 publications

References 19 publications

Starr-Edwards caged ball valve pursuing to astonish us-38 years in mitral position

Starr-Edwards caged ball valve pursuing to astonish us-38 years in mitral position

Valve Dysfunction of the Cloth-Covered Starr-Edwards Ball Valve

Severe Hemolysis Due to Cloth Wear 23 Years after Aortic Valve Replacement on a Starr—Edwards Ball Valve Model 2320

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