title: Late re-operation for aortic and mitral Starr-Edwards ball valve prostheses.
abstract: Starr-Edwards ball valves removed more than 15 years after implantation were retrospectively investigated macroscopically. Eight patients required re-operation. Valve models used in the initial operations were a non-cloth-covered valve in 2 patients and a cloth-covered valve in 6. Two patients had replacement of an aortic ball valve (model 1260 and model 2320) and 6 underwent mitral valve replacement (model 6120 in one, model 6320 in 5). The mean time to re-operation was 23.0 +/- 4.8 years after implantation. Cloth wear causing significant hemolysis was observed in all cloth-covered valves, regardless of valve position. Autologous tissue growth was noted on the orifice ring and struts in both aortic and mitral prostheses. Thrombus formation was not found in any of the valves. Ball variance in silicone rubber balls was mild in the non-cloth-covered valves, even in the aortic position. The most significant problem with the cloth-covered ball valve was cloth wear. Cloth wear should always be considered when 15 years or more have passed since valve implantation. Significant hemolysis, elevation of lactate dehydrogenase values, and echocardiographic detection of transvalvular regurgitation are diagnostic of cloth wear, and are indications for replacement of a cloth-covered ball valve.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. aoyagi@med.kurume-u.ac.jp
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Aoyagi
authors.forename: Shuji
authors.initials: S
authors.lastname: Fukunaga
authors.forename: Koichi
authors.initials: K
authors.lastname: Arinaga
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yokokura
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yokokura
authors.forename: Noriko
authors.initials: N
authors.lastname: Egawa
mesh_terms: D000328:Adult; D001021:Aortic Valve; D020878:Device Removal; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011475:Prosthesis Failure; D012086:Reoperation