Lessons from the past: twenty-five years experience with the Cross-Jones caged disc prosthesis.
One hundred and twenty-one patients who received 145 Cross-Jones prostheses between 1967 and 1973 were followed for over 20 years. Thirty-six patients had undergone single aortic valve replacement, receiving an uncovered prosthesis (Group A), while 83 of the 85 patients in Group B undergoing isolated mitral or combined mitral and aortic and/or tricuspid replacements received a cloth-covered prosthesis in the mitral and/or tricuspid position. There were no mechanical failures in Group A, and three patients are alive 24 years after their operations. The seat was smooth in all prostheses inspected at autopsy and the disc was not worn even 15-18 years after surgery. The overall incidence of thromboembolism in this group was 3.56%/pty, of which 2.13%/pty were fatal. All operative offvivors with cloth-covered valves developed mechanical dysfunction leading to death or requiring reoperation within ten years. The cloth cover was invariably disrupted and the disc hitting this rough surface had become worn, with significant diminution in their diameters in all valves recovered during reoperation or at autopsy. In seven patients, the disc escaped from a mitral prosthesis causing immediate death, while one patient survived a tricuspid disc escape for over one month and was then successfully reoperated. The overall incidence of thromboembolism in Group B was 23.4%/pty, of which 11.7%/pty were fatal.
Kovacs
G S
GS
Department of Cardiac Surgery, Albert Szent-Györgyi Medical University, Szeged, Hungary.
Felkai
B
B
Toszegi
A M
AM
D000206:Actuarial Analysis; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D004696:Endocarditis / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D013499:Surface Properties; D015996:Survival Rate; D013923:Thromboembolism / Q000453:epidemiology / Q000401:mortality; D014261:Tricuspid Valve / Q000601:surgery