Ball valve (Smeloff-Cutter) aortic valve replacement without anticoagulation.
BACKGROUND
Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution for 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 Smeloff-Cutter ball valve might be a valid alternative for young patients unable to maintain regular anticoagulation.
Department of Cardiovascular Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Gometza
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Duran
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D001022:Aortic Valve Insufficiency / Q000188:drug therapy / Q000601:surgery*; D001241:Aspirin / Q000008:administration & dosage; D002648:Child; D004176:Dipyridamole / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D001241:Aspirin