Late complications of aortic valve replacement with cloth-covered, composite-seat prostheses. A six-year appraisal.
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.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin