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PubMed1997

Donor valves as substitutes for heart valve replacement.

The main problems of heart valve replacement in Sri Lanka are the cost of prosthetic valves and anticoagulant related complications. The use of human donor heart valves (homografts; allogeneic heart valves [AHV]) will alleviate these shortcomings. Recipients of AHV do not require anticoagulant therapy. Moreover, cryopreservation of AHV offers the opportunity for the storage of valves for an extended length of time with the preservation of valve integrity which is essential for their function after implantation. A donor valve bank can potentially provide diameter matched valves for recipients. Current research suggests that the adverse immunological reactions initiated by AHV cause tissue degeneration in a proportion of these implants. However, the grafts may be improved before implantation during the disinfection and storage of the valves. In this essay an overview on the advantages of using AHV, current concepts of valve banking, recent advances in the understanding of AHV immunogenicity, emerging techniques for immunomodulation of AHV and the possibility of setting up a donor heart valve bank in Sri Lanka are discussed.

Heart Valves↗
PubMed2005

First report on a human percutaneous transluminal implantation of a self-expanding valve prosthesis for interventional treatment of aortic valve stenosis.

BACKGROUND: Percutaneous aortic valve replacement is a new technology for the treatment of patients with significant aortic valve stenosis. We present the first report on a human implantation of a self-expanding aortic valve prosthesis, which is composed of three bovine pericardial leaflets inserted within a self-expanding nitinol stent. The 73-year-old woman presented with severe symptomatic aortic valve stenosis (mean transvalvular gradient of 45 mmHg; valve area of 0.7 cm2). Surgical valve replacement had been declined for the patient because of comorbidities, including previous bypass surgery. METHOD AND RESULTS: A retrograde approach via the common iliac artery was used for valve deployment. The contralateral femoral vessels were used for a temporary extracorporal circulation, unloading the left ventricle during the actual stent expansion. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially during the procedure. Clinical and echocardiographic follow-up at day 1, 2, and 14 post procedure was performed to evaluate the short-term outcome. The prosthesis was successfully deployed within the native aortic valve, with accurate and stable positioning and with no impairment of the coronary artery or vein graft blood flow. 2D and doppler echo immediately after device deployment showed a significant reduction in transaortic mean pressure gradient (from 45 to 8 mmHg) without evidence of aortic or mitral valve insufficiency. The clinical status has then significantly improved. These results remained unchanged up to the day 14 follow-up. CONCLUSION: This case report demonstrates a successful percutaneous implantation of a self-expanding aortic valve prosthesis with remarkable functional and clinical improvements in the acute and short-term outcome.

Aged↗
PubMed2005

Aortic valve repair for rheumatic aortic valve disease.

BACKGROUND: The aim of this study is to assess the long-term results of aortic valve repair in patients with rheumatic aortic valve disease. METHODS: From April 1991 through December 2003, 61 patients with rheumatic aortic valve disease underwent aortic valve repair. Mean age was 23.7 +/- 9.3 years (range, 6 to 53 years). Thirty-nine (63.9%) patients were in New York Heart Association functional class III. Reparative procedures included cuspal thinning (n = 59), commissurotomy (n = 45), subcommissural annuloplasty (n = 24), commissural plication (n = 12), perforation closure using pericardium (n = 2), and decalcification of cusps (n = 2). Associated procedures included mitral valve repair (n = 36) and tricuspid valve repair with mitral valve repair (n = 5). RESULTS: Early mortality was 4.9% (3 patients). Mean follow-up was 93.8 +/- 46.4 months (range, 6 to 160 months, median, 103 months). Forty-six survivors (65%) had no or trivial or mild aortic regurgitation. Four patients required reoperation for valve dysfunction. There were no late deaths. Actuarial and reoperation-free survival, at 160 months, was 95.2% +/- 2.8% and 85.4% +/- 6.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 52.4% +/- 16.9%. CONCLUSIONS: Aortic valve repair in patients with rheumatic aortic valve disease is feasible and yields gratifying long-term results.

Adolescent↗
PubMed2001

Clinical outcomes after aortic valve replacement with the Toronto stentless porcine valve.

BACKGROUND: Hemodynamic benefits of the Toronto stentless porcine valve have been documented. Clinical well-being and freedom from major valve-related events have been less well defined. METHODS: A total of 447 patients were prospectively followed for up to 8 years (1,745.2 valve years total, 3.9 valve years/patient). The patient demographics included 66% men, mean age 65 years, New York Heart Association functional class III-IV 55%, concomitant coronary artery bypass grafting 41%. RESULTS: We found that 83.7% of patients were in New York Heart Association functional class I and 80.8% had 0 to 1+ aortic insufficiency. Mean gradient at 6 years (n = 75) was 4.4 mm Hg and mean effective orifice area (EOA) 2.4 cm2. Late adverse event rates per patient per year were: embolism 1.0%, endocarditis 0.4%, thrombosis 0%, structural deterioration 0.2%, explant 0.3%, and valve-related death 0.6%. Freedom from valve-related death at 6 years was 95.8%; from cardiac death 96.3%. Freedom from endocarditis was 98.4%, from embolism 93.9%, from structural deterioration 97.4%, and freedom from explant 98.1%. For patients older than 60 years, freedom from structural deterioration was 100%. CONCLUSIONS: These results confirm satisfactory clinical outcomes after aortic valve replacement with the Toronto stentless porcine valve, with a low incidence of valve-related adverse events as long as 96 months after valve replacement.

Adult↗
PubMed1978

Is the Hancock porcine valve the best cardiac valve substitute today?

Valve replacement with the Hancock stabilized glutaraldehyde porcine aortic valve has been accomplished in 454 patients. Hospital mortality (influenced by a high proportion of patients in New York Heart Association Functional Class IV) was 17.6% (80/454). The first 221 patients discharged from hospital were followed for 36 to 75 months after valve replacement. There have been 26 late deaths among these patients; 88% (195/221) are alive. Of these 221 patients, 185 had single-valve replacement, (125 mitral and 60 aortic), and 36 underwent multiple-valve replacement. There have been 260 valves at risk up to 6 1/4 years, which is equivalent to 12,984.5 valve-months or 1,082 valve-years. Average follow-up is 4.16 years. There have been 13 valve failures in 10 patients. In 4 patients endocarditis was proved to be the cause of failure, and in 5 it was suspected; in 1 patient the failure the failure is unexplained. The pathological similarity between those in whom infection was documented and the other 5 is remarkable and raises the question of whether low-grade infections may be the cause of certain types of valve failure.

Adolescent↗
PubMed2002

Intraoperative transesophageal echocardiographic assessment of acute prosthetic aortic valve regurgitation after mitral valve replacement: value of the deep transgastric long-axis view.

The transesophageal echocardiographic assessment of prosthetic aortic valve function is made more difficult by the presence of a mechanical mitral valve prosthesis because echocardiographic views conventionally used to assess the aortic valve function are obscured by acoustic shadowing and artifacts. We report the use of intraoperative transesophageal echocardiography in a patient who developed severe prosthetic aortic valve regurgitation after implantation of a mechanical mitral valve, in whom conventional multiplane midesophageal views failed to reveal aortic regurgitation owing to acoustic shadowing and artifacts from the prosthetic mitral valve. We report the value of the deep transgastric long-axis view of the aortic valve that provided an unobstructed view of the left-ventricular outflow tract, and clearly demonstrated severe aortic regurgitation as a result of interference with the prosthetic aortic valve mechanism by the implanted mitral valve prosthesis. This case also emphasizes the importance of a comprehensive intraoperative transesophageal examination, including that of surrounding structures, to detect iatrogenic complications during mitral valve replacement.

Acute Disease↗
PubMed1991

Effect of stent mounting on tissue valves for aortic valve replacement.

Stent mounting of homograft valves was first reported by our group in 1968. Since then, there has been question as to whether or not stent mounting of bioprostheses adversely affects the incidence of structural deterioration in aortic valve replacement. Between November 1967 and July 1988, 571 consecutive patients underwent valve replacement with a stented or unstented homograft. There were 351 men (61.5%) and 220 women (38.5%). The mean age of the group was 49.2 years (range 18 to 79 years). Five hundred thirty-four patients left the hospital (30-day overall mortality 6.5%). Follow-up extends from 6 months to 22 years with a mean of 7.6 years. The cumulative follow-up for the series was 4,095.9 patient-years. Hospital mortality, early technical failure, and prosthetic valve endocarditis were considered censoring events and excluded from this study. Actuarial analysis revealed a significant difference (p less than 0.02) in the freedom from structural valve deterioration for unstented and stended isolated aortic valve replacement. Age (50 and under, and over 50) does not appear to be a factor in structural deterioration in unstented homografts but does influence the rate of failure in stented homografts (p less than 0.05). These results clearly indicate that stent mounting adversely affects tissue valve durability with aortic valve replacement. Moreover, age correlates with structural deterioration if valves are stented and does not if they are unstented. Based on these results, the use of unstented bioprostheses should be reevaluated, along with the design of porcine valve stents.

Adolescent↗
PubMedDate not supplied

Timing of aortic valve replacement in elderly patients with symptomatic aortic valve disease using outpatient clinical parameters.

OBJECTIVE: To determine by how far worsening outpatient clinical parameters can affect outcome after aortic valve replacement, in patients with preserved left ventricular function and symptomatic aortic valve disease. PATIENTS AND METHODS: Five hundred patients with aortic valve disease underwent aortic valve replacement using a bioprosthesis. In 348 patients, another procedure was added. The preoperative outpatient parameters were investigated for their effect on hospital and long-term mortality. A Fisher exact, Kaplan-Meier univariate and Cox proportional hazard analysis were used. RESULTS: A retrospective follow-up of 2022 patient years was obtained. Five preoperative parameters were found to be more present in patients with a decreased left ventricular function: 1) severity of symptoms, 2) previous myocardial infarction, 3) conduction defects, 4) aortic valve regurgitation and 5) increasing need for medication. In patients with an ejection fraction of 50% or more, logistic regression analysis showed that hospital mortality increased with need for medication (p=0.004), previously performed CABG (0.015), increase in symptoms (p=0.018) and myocardial infarction (p=0.034). A Kaplan-Meier analysis revealed aortic valve regurgitation (p=0.017) and increased need for medication (p=0.012) as significant on long-term survival. Presence of a previous myocardial infarction showed a trend (p=0.062). A Cox' proportional hazard analysis showed for global mortality increased need for medication (p=0.010) and previous myocardial infarction (p=0.018) as independent factors and for long-term mortality, this was aortic valve regurgitation (p=0.001). CONCLUSIONS: Results after aortic valve replacement deteriorate with the presence of valve regurgitation, a preoperative myocardial infarction, increasing need for medication or severity of symptoms, even for an ejection fraction of 50% or more. Anamnesis with special care to the degree of symptoms and increasing need for medication early in the valve disease could lead to early referral, thereby reducing number of patients with severe symptoms and improving postoperative results.

Age Factors↗
PubMed2005

The Ross operation: utilization of the patient's own pulmonary valve as a replacement device for the diseased aortic valve.

Prosthetic heart valves have been outpaced by progress in cardiac surgery. Early biologic valve prostheses consisted of tissues mounted on a rigid stent, and did not require anticoagulation, but rarely survived two decades. Subsequently, durable mechanical valve prostheses dominated despite, the requisite anticoagulation. The mechanical design remains imperfect, with obstruction to flow, turbulence, hematological changes and also, occasionally audible clicks. Reports documenting superior function for cryopreserved human aortic heart valves (homografts) without these problems, albeit with limited durability, followed. The marketing of 'stentless biologic valves', mimicking these attributes was a reaction to the shortage of homografts. These imperfections explain the rediscovery of the Ross operation, in which the patient's pulmonary valve (autograft) is excised to replace the aortic valve. The autograft is living tissue, complete with attributes of a healthy heart valve, including growth and durability. The pulmonary valve, where lower pressure and oxygen saturation retards degeneration, is substituted with a pulmonary homograft. The Ross operation is exacting and leaves the patient with two potentially malfunctioning valves.

Aortic Valve↗
PubMed2000

Should a regurgitant mitral valve be replaced simulataneously with a stenotic aortic valve?

Mitral valve regurgitation frequently accompanies aortic valve stenosis. It has been suggested that mitral regurgitation improves after aortic valve replacement alone and that the mitral valve need not be replaced simultaneously Furthermore, mitral regurgitation associated with coronary artery disease, particularly in patients with poor left ventricular function, shows immediate improvement after coronary artery bypass grafting. We studied 60 consecutive patients with aortic stenosis and mitral regurgitation to determine the degree of improvement in mitral regurgitation after aortic valve replacement alone versus aortic valve replacement combined with coronary artery bypass grafting. Thirty-six of the patients had normal coronary arteries (Group 1); the other 24 had symptomatic coronary artery disease requiring bypass surgery (Group 2). Echocardiography was performed preoperatively, 1 week postoperatively, and at follow-up. In Group 1, left ventricular ejection fraction did not improve early or at 2.5 months postoperatively, but mitral regurgitation improved gradually during follow-up. In Group 2, mitral regurgitation showed improvement 1 week postoperatively (p < 0.001), and left ventricular ejection fraction was improved at 2.5 months. We conclude that patients with aortic valve stenosis and mild-to-severe mitral regurgitation, without echocardiographic signs of chordal or papillary muscle rupture and without coronary artery disease, should undergo aortic valve replacement alone. The mitral regurgitation will remain the same or improve. For patients with coexisting coronary artery disease, simultaneous aortic valve replacement and coronary artery bypass grafting are imperative; however, the mitral valve again requires no intervention, since mitral regurgitation improves significantly after the other 2 procedures.

Adult↗
PubMed2001

Mechanical versus biological valve prosthesis in the mitral position: a 10-year follow up of St. Jude Medical and Biocor valves.

BACKGROUND AND AIM OF THE STUDY: During the past 30 years, the development of mechanical and biological valves has led to major improvements in patient survival. Here, we present long-term results obtained with both types of prosthesis. METHODS: At our institution, between 1985 and 1989, 158 patients received a Biocor porcine bioprosthesis, and 100 patients a St. Jude Medical (SJM) mechanical valve. Preoperatively, mean age, male:female ratio, NYHA functional class and pathology of mitral valve disease were similar in both groups. RESULTS: The 30-day mortality was 4.4% in the Biocor group and 4% in the SJM group, the major cause being congestive heart failure. Late mortality was 17.9% and 15.6% respectively in the two groups, but valve-related mortality was very low in both (1.3% versus 4.2%). Ten-year survival was similar in each group (77.8+/-3.4% versus 81.0+/-3.9%; p = 0.538). Ten-year freedom from anticoagulant-related hemorrhage was higher with Biocor prostheses (99.3+/-0.7% versus 90.9+/-3.1%; p = 0.007). Valve thrombosis was seen only in the SJM group, and structural valve degeneration (SVD) only in the Biocor group. Ten-year freedom from reoperation was lower in the Biocor group (84.9+/-3.2% versus 92.2+/-2.8%; p = 0.206). The significant causes of reoperation were SVD in the Biocor group and valve thrombosis in the SJM group. Freedom from prosthetic valve endocarditis was similar in both groups (96.3+/-1.6% versus 95.5+/-2.2%). CONCLUSION: As no difference was seen in survival and reoperation rates between patients receiving either bioprostheses or mechanical valves, the valve used will depend on the surgeon's choice and the type of patient, notably elderly patients who are intolerant of anticoagulation, and young women wishing to have children.

Adolescent↗
PubMed2003

Intraoperative assessment of mitral valve and peri-operative results of surgical treatment of mitral valve disease in patients who previously underwent closed surgical and percutaneous transluminal mitral commissurotomy.

BACKGROUND: Surgical open or closed mitral commisurotomy and percutaneous transluminal mitral commissurotomy (PTMC) are the well-established therapies in patients with mitral valve stenosis. However, due to various factors the long-term effects may not be optimal in some patients, so they should undergo surgical mitral valve replacement. AIM: The intra-operative assessment of the morphology of mitral valve and the evaluation of the peri-operative results of surgical treatment in patients with mitral valve disease who previously underwent closed surgical commissurotomy followed by PTMC. METHODS: Twenty one patients (20 males, mean age 49 years) who underwent surgery due to mitral valve disease after closed mitral commissurotomy and PTMC, are presented. The time from closed mitral commissurotomy to PTMC was 3-42 years, and the time from PTMC to mitral valve replacement - 9 days to almost 9 years. RESULTS: One patient died on the second day after the operation because of left ventricular failure. The outcome of the remaining patients was good. Advanced changes of the mitral valve and subvalvular apparatus were present in the majority of patients. CONCLUSIONS: The results of the implantation of mitral valve prosthesis in patients who previously underwent closed surgical mitral commissurotomy and PTMC are good. In some patients with a history of closed surgical mitral commissurotomy, PTMC delays surgical replacement of the mitral valve. Advanced changes in the mitral valve leaflets and subvalvular apparatus are the causes of PTMC failure.

Adult↗
PubMed2005

Mechanical valve thrombosis in a chronic animal model: differences between monoleaflet and bileaflet valves.

BACKGROUND AND AIM OF THE STUDY: The occurrence of mechanical valve thrombosis was studied in a chronic sheep model of valve implantation in the pulmonary position. METHODS: Six monoleaflet and six bileaflet mechanical valves were implanted in young sheep. Anticoagulation was stopped at one week postoperatively, after which weekly fluoroscopic evaluation was performed. Animals were sacrificed at the moment of any abnormality on the fluoroscopic image or, if no abnormality occurred, at fixed time intervals of two and three months. After explantation, valves were examined macroscopically, by stereomicroscopy, histology and scanning electron microscopy. Lung biopsies were taken. RESULTS: All monoleaflet valves remained functionally intact for up to three months without anticoagulation, but explantation after two or three months revealed thrombi attached to struts, cuspal surface and valve ring. All bileaflet valves, except one, showed obvious dysfunction on fluoroscopy (one or both cusps fixed) within a time frame of three to eight weeks after implantation. Histology and scanning electron microscopy showed primary thrombotic material in one or both hinges, obstructing further cusp movement. Lung embolism was detected in only one animal among biopsy specimens. CONCLUSION: The low-pressure environment of the pulmonary position caused primary thrombotic changes in all implanted mechanical valves. The thrombosis caused severe mechanical dysfunction only in the bileaflet valves, probably due to their delicate hinge mechanism. These findings may be used in the further development of an animal model of mechanical valve thrombosis.

Animals↗
PubMed1990

[On the mechanisms of mitral regurgitation in rheumatic mitral valve disease: with special reference to the role of mitral valve prolapse].

To assess the role of mitral valve prolapse (MVP) in the pathogenesis of mitral regurgitation (MR) in rheumatic mitral valve disease (RMD), we performed phonocardiography (PCG), transthoracic and transesophageal two-dimensional and color Doppler (CD) echocardiography in 22 patients with RMD including three with pure mitral stenosis (MS), 11 with predominant MS, six with predominant MR and two with pure MR. Results were as follows: 1. Prolapse of the mitral valve (MV) was differentiated from systolic ballooning of the whole MV by the findings that the anterior leaflet's tip (rough zone) protruded into the left atrium with an acute angle between the body (clear zone) and rough zones of the anterior MV and that the posterior leaflet protruded markedly above the level of the mitral ring. 2. MR was detected in six patients (slight MR) by only the CD method and in 13 (mild, moderate or greater MR) by both the PCG and CD methods. 3. MR was absent or slight in five patients (three of pure MS and two of predominant MS) without valve thickening and with systolic ballooning of the whole valve due to commissural fusion. 4. Mitral valve abnormalities related to significant (mild, moderate or severe) MR were dependent on valve thickening (five patients), prolapse of the leaflet's tip toward the left atrium (four), or both (four). 5. An apical systolic click was found in only one of the nine patients with systolic ballooning, but in four of 11 with MVP. 6. The MR murmur in six of the nine patients with valve thickening showed the decrescendo or flat contour, but that in four of the eight patients with MVP showed a crescendo contour. From these results, we concluded that mitral valve prolapse should be considered as one of the important causes of mitral regurgitation in rheumatic mitral valve disease.

Adult↗
PubMed1995

The influence of age on valve related events with Carpentier-Edwards pericardial valves.

From July 1984 to December 1991, 641 Carpentier-Edwards pericardial valves were used in 585 consecutive patients. There were 420 aortic valve replacements, 121 mitral valve replacements, and 50 double valve replacements. Mean age was 65.5 +/- 12 years. All patients but 10 were followed up at 3 months periods with a total follow-up of 2074 patients years and a mean follow-up of 3.7 years. Patients were subdivided in 4 groups: Group I: < 50 years, Group II: 50 < age < 65, Group III: 65 < age < 75, Group IV: > 75 years. Actuarial survival rates were 100% in group I, 80 +/- 9% in group II, 68 +/- 11% in group III, and 64 +/- 13% in group IV. Valve related complications included 54 patients and valve related deaths 17. Valve related death rates were 100%, 96 +/- 3%, 95 +/- 4%, 89 +/- 10% respectively (NS). We observed 4 structural failure of the values with respective rates of freedom from valve deterioration of: 92 +/- 6%, 98 +/- 2%, 100%, 100% (NS). No leaflet tears were observed. No difference was found between the 4 age groups in terms of valve related events except for thromboembolic accidents which were more frequent in patients older than 75 years. The absence of difference at 8 years and the absence of leaflet tears indicate the superiority of the Carpentier-Edwards pericardial over previous bioprostheses and the better stress behaviour of this valve. The coming years will allow us to determine the precise place of this pericardial device, especially in young patients and in the mitral position.

Actuarial Analysis↗
PubMed1994

Mitral valve replacement with the Biocor stentless mitral valve: early results.

Chordal preservation during mitral valve replacement is thought to greatly preserve left ventricular function. Recently a stentless mitral valve (Biocor) became available for clinical use. It is a porcine mitral valve with the entire chordal apparatus, the sewing ring being reinforced by a bovine pericardial ring and the chordae being sutured together onto two pericardial patches. During a six months period, seven patients undergoing mitral valve replacement for mitral insufficiency (four cases), mitral stenosis (two cases) or mixed lesions (one case) received a stentless mitral valve. Their mean age was 66.3 +/- 4.8. The valve was implanted by suturing the pericardial patches onto the papillary muscles and the sewing ring onto the mitral annulus. Echocardiography control immediately after surgery showed good valve function. Three valves failed after a period of seven days, seven and 12 months respectively. The valve lesions were similar and consistent with an excessive tension on the chordae and on the valvular tissue. There were tears along the posterior annulus and at the level of the commissures, often accompanied by chordal rupture. Histology and scanning electron microscopy showed good integration of the prosthesis with the patients own tissues. There were areas of overgrowing tissue without endothelial cells especially in the area of papillary muscle -pericardial patch interaction. The remaining four patients continue to do well after a mean follow up of two years. The apparent excessive tension on the valve tissues leading to the premature failure of the prosthesis could be due to the variability in the distance between mitral annulus and papillary muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Hydrodynamic performance of Carbomedics valves in double valve replacement.

Most patients undergoing double valve replacements have reduced myocardial capacity. However, little is known about the influence of valve sizes on myocardial energy consumption in double valve replacement. This study was designed to supply hydrodynamic data for the proper selection of sizes in double valve replacement. A mock loop system was used to measure the energy consumption of CarboMedics valves at conditions resembling rest (5 L/min) and moderate exercise (9 L/min). All combinations of aortic valves size #21 to #27 with mitral prosthesis sizes #25 to #29 were tested separately. Larger size aortic prostheses revealed remarkably less energy consumption up to size #27. Under high flow (9 L/min) this effect was more pronounced. In contrast, mitral valve prosthesis sizes #25 to #29 had similar hydrodynamic data. At low flow conditions (5 L/min) no significant benefit was found with the use of a larger mitral valve. Only a reduction of less than 10 percent of total energy consumption could be achieved with the use of a mitral valve larger than #25 at 9 L/min flow. In conclusion there is no hydrodynamic reason for using a valve larger than #25 in the mitral position for patients who exercise moderately. Continuous reduction of cardiac work can be expected with the use of the largest possible aortic prosthesis up to size #27 at rest and at moderate exercise.

Aortic Valve↗
PubMed1996

[Surgical results of valve replacement with the Björk-Shiley tilting disc valves].

We evaluated the Björk-Shiley tilting-disc (BS) valve replacement up to the longest duration for about 12 years. The study was started in November 1982 and ended in September 1991. There were total number of 206 with 117 males and 89 females aged between 18 and 71 with a mean of 51.6. Eighty three patients had isolated aortic valve replacement (AVR), 92 had isolated mitral valve replacement (MVR), and 31 had AVR plus MVR. One hundred and fourteen spherical-disc valves were replaced in the aortic, 112 spherical and 11 monostrut in the mitral position. The mean duration of follow up was 6.5 years for a total of 1330.6 patient years (PY). Forty-one patients (3.8%/PY) died later, and 14 out of 41 died of valve-related complications. Actuarial survival rates for all, AVR, MVR and DVR at 10 years after operation were 71.2%, 73.5%, 73.9% and 55.4%, respectively. The linearized rates of thromboembolism (TE), thrombosed valve (TV), anticoagulant-related hemorrhage (ACH), prosthetic valve endocarditis (PVE), hemolysis (H), and reoperation (RO) were 1.2%/PY, 0.2%/PY, 0.7%/PY, 0.2%/PY, 0.1%/PY, and 0.2%/PY, respectively. The rates of freedom from TE, TV, ACH, PVE, H, and RO and 10 years after operation were 83.5%, 98.5%, 94.0%, 98.4%, 99.0% and 95.6%, respectively. The major causes of postoperative mortality and morbidity were TE, TV, and ACH. One hundred and fifty-six out of 161 patients showed an improvement in NYHA functional class post operatively. The surgical results of valve replacement with the BS valve was excellent and acceptable one. Intensive management with a special reference of anticoagulant therapy is necessary for a long-term management of the patients with mechanical valve replacement.

Adolescent↗