The Annals of Thoracic Surgery, Vol 19, 289-300, Copyright © 1975 by The Society of Thoracic Surgeons
Late complications of aortic valve replacement with cloth-covered, composite-seat prostheses. A six-year appraisal
A Starr, LI Bonchek, RP Anderson, JA Wood and RD Chapman
Advanced actuarial techniques are used to analyze early and late results in
a closely followed series of 396 patients who received a cloth-covered,
composite-seat aortic prosthesis. Late mortality and various complications
are carefully assessed, and most late deaths are seen to be unrelated to
the prosthesis. One hundred sixteen patients with Model 2310-2320
prostheses who received warfarin postoperatively had no thromboembolic
complications in 360 patient-years of follow-up (average, 3.1 years per
patient); 134 patients who had the same prosthesis but did not receive
warfarin had 9 emboli per 100 patient- years (average follow-up, 1.7 years
per patient; total, 228 patient- years). By comparison, in 9 years'
experience with non-cloth-covered Model 1200-1260 valves, 132 patients had
4.0 emboli per 100 patient- years (average follow-up, 5.1 years; total, 673
patient-years). The safety of cloth-covered valves is clearly enhanced by
concomitant use of anticoagulants; the possibility that antiplatelet drugs
may suffice has not yet been demonstrated. Strut cloth wear was found at
reoperation in 10 patients. The Model 2400 composite strut ("track") valve
with a narrow metal track on the inner surface of each strut prevents this
complication.
