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Ann Thorac Surg 2004;78:384
© 2004 The Society of Thoracic Surgeons

Correspondence

Long-term durability of three mechanical valves

Jean-Marie T. A. De Smet, MD, Constantin Stefanidis, MD, Martine Antoine, MD, Georges Primo, MD

Service of Cardiac Surgery, C.U.B. Hopital Erasme, University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium

e-mail: jean-marie.de.smet{at}ulb.ac.be

To the Editor:

The interesting case report by Naito and associates [1] describing 28-year durability of Smeloff-Cutter aortic prosthesis leads us to report a similar case of long-term function of three mechanical valves in 1 patient.

The patient underwent operation in March 1975 at the age of 24 years for rheumatic triple-valve disease. He received a 23-mm Bork-Shiley aortic valve, a 29-mm Smeloff-Cutter mitral valve, and a 31-mm Smeloff-Cutter tricuspid valve. His health history was uneventful until 1992, when atrial fibrillation appeared. Because of progressively deteriorating heart function, he was evaluated in 2002 for cardiac transplantation. The three valves functioned normally, but the heart was severely dilated as a result of a terminal state of valvular cardiomyopathy.

Cardiac transplantation was performed in May 2003, 28 years 2 months after the first operation. The explanted heart showed intact mechanical prostheses without thrombi, pannus formation, or paravalvular leaks. The two silicone balls appeared well preserved. Recovery was uneventful.

Triple-valve replacement carries a high perioperative morbidity and mortality, and long-term survival at 10 years was only 50% in a 2002 report by Carrier and coauthors [2]. These outcomes are influenced by preoperative clinical conditions, and in favorable instances, as in the case of our patient, length of survival can be better. Mechanical valve replacement is further complicated by the continuing controversy concerning the choice of valve for the tricuspid position. Van Nooten and colleagues [3] favored mechanical valves for patients with a good long-term prognosis, whereas Tayama and associates [4], noting a high degree of bileaflet mechanical valve thrombosis in the tricuspid position, currently prefer bioprosthetic valves.

The choice of a disc valve in the aortic position in our patient was probably made to avoid the higher gradient of a ball valve when poststenotic dilatation is absent, as discussed by Naito and co-workers.

Although we fully agree with the conclusions of Naito and associates, it is noteworthy that the combination of valve types in our patient proved retrospectively to be optimal. He avoided reoperation for bioprosthetic failure or mechanical valve thrombosis and obtained good-quality long-term survival.

References

  1. Naito Y., Nakajima M., Inoue H., Hibino N., Mizutani E., Tsuchiya K. Unexpected durability of Smeloff-Cutter aortic ball valve prosthesis. Ann Thorac Surg 2003;75:1633-1635.[Abstract/Free Full Text]
  2. Carrier M., Pellerin M., Bouchard D., et al. Long-term results with triple valve surgery. Ann Thorac Surg 2002;73:44-47.[Abstract/Free Full Text]
  3. Van Nooten G., Caes F., Taeymans Y., et al. Tricuspid valve replacement: postoperative and long-term results. J Thorac Cardiovasc Surg 1995;110:672-679.[Abstract/Free Full Text]
  4. Tayama E., Kawano H., Takaseya T., et al. Triple valve replacement with bileaflet mechanical valves: is the mechanical valve the proper choice for the tricuspid position?. Jpn Circ J 2001;65:257-260.[Medline]




This Article
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Martine Antoine
Georges Primo
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