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Ann Thorac Surg 1995;60:1312-1316
© 1995 The Society of Thoracic Surgeons

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Articles

Ball valve (smeloff-cutter) aortic valve replacement without anticoagulation

Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Accepted for publication June 17, 1995.

^* Address reprint requests to Dr Duran, The International Heart Institute of Montana Foundation, 554 W Broadway, Missoula, MT 59802.

Background.: Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution of aortic valve replacement in selected patients without permanent anticoagulation therapy.

Methods.: The availability of a satisfactory follow-up system since July 1988 suggested a study of all 47 patients operated on since then and followed for a mean of 43.2 months (range, 16 to 78 months). Mean age was 26.3 years, 98% were in sinus rhythm, and 16 patients (34%) had concomitant mitral repair.

Results.: There were no hospital deaths. Three patients were lost to follow-up at a mean of 27 months. Four late deaths occurred (8.5%), two of them sudden, with actuarial survival at 6 years of 91% ± 4.3%. There were a total of five embolic events (2.9%/patient-year). For isolated aortic valve replacement only, with antiaggregant therapy (n = 29), the incidence was 0.9%/patient-year. For all patients receiving antiaggregant agents (n = 43), it was 3.02%/patient-year. There were no known cases of valve thrombosis. Reoperation was required in 5 patients.

Conclusions.: Aortic valve replacement with the Smelloff-Cutter ball valve might be a valid alternative for young patients unable to maintain regular anticoagulation.

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