Late Results of Operation for Acquired Aortic Valvular Disease

Abstract

Of the 614 open-heart operations performed at the Mayo Clinic for acquired aortic valvular disease, 130 were performed on patients who also required repair of other valves. Review of the remaining 484 operations resulted in the following observations. Operation for acquired aortic valvular disease may now be accomplished with a hospital mortality rate of 4%. The incidence of late death and failure of patients to improve has averaged 44% for previously employed techniques of valvular repair. Failure of the valve or prosthesis to function properly was the most common cause of late failure after operations in which these earlier methods were used. In the 138 more recent cases, in which operations employing the aortic ball valve (Starr-Edwards prosthesis) were used, the incidence of late failure has been reduced to 14%, and failure of the prosthesis to function properly has not yet occurred in the absence of infection. Late bacterial endocarditis and thromboembolism were the most serious problems associated with use of the ball-valve prosthesis. In contrast with the late results of the former techniques, use of the ball valve has resulted in improvement for 79% of the patients; in the great majority of these there has been a dramatic return to normal living. Despite the highly satisfactory results of current methods, the fact that 14% of patients have already died after an initially successful operative result, and that another 12% have suffered complications causing their late result to be less than totally satisfactory, indicates that the policy of recommending for operation only those patients who have significant and progressive cardiac disability should be continued.

Survival After Starr-Edwards Aortic Valve Replacement

“…All but two of these patients were on anticoagulants Causes of late deaths in this series encompassed a wide spectrum. As in other series, 8,17,20 the number of sudden deaths and deaths due to persistent congestive heart failure and myocardial infarction was relatively high. Twelve patients died suddenly, and eight died in unremitting congestive failure.…”

Homograft valve replacement for aortic valve disease.

“…The hospital mortality of 4-4% in patients with isolated aortic valve disease compares very favourably with the best results that have been reported with the Starr-Edwards ball valve (McGoon, Ellis, and Kirklin, 1965), and there seems little doubt that when more confidence has been gained in the long-term behaviour of the homograft valve and when surgery can therefore be offered to better risk patients it will fall to even lower levels. The operative risk appears to be lower in isolated aortic incompetence (2-4%) than in calcific aortic stenosis (6%), perhaps because the former patients tend to be younger.…”

Debridement-valvotomy for aortic stenosis in adults: A follow-up of 76 patients

“…This includes four Teflon cusp fatalities, who are included since the necessity for cusp replacement was an expression of a failed debridement. Hospital mortality rates in other large series vary considerably; with Mulder, Kattus, Fonkalsrud, and Longmire (1963) hospital mortality was 14%, with McGoon, Ellis, andKirklin (1965) 14%, Cronin, Reid, Scott, andDobell (1963) 25%, Scannell, Shaw, Burke, Austen, andSaurbrey (1963) 27%, andBaker andSomerville (1964) 31 %. Considerably better results were achieved by Morrow, Austen, and Braunwald (1963) with an 8% hospital mortality, by Hufnagel andConrad (1962) 6%, andHancock, Hultgren, andShumway (1965) Scannell et al (1963) 9% over two to five years, Hancock et al (1965) 10% over an average of 28 months, andMorrow et al (1963) 8 % andHufnagel andConrad (1962) 12% over one year.…”

“…been suggested (McGoon et al, 1965) that the operation may still have a place in cases where valve calcification is not heavy. Our series does not support this contention.…”