The results of long-term follow-up study for 445 cases of valve replacement with various kinds of cardiac prostheses--comparison of the clinical results among the groups using different types of valves and with or without postoperative anticoagulant therapy
Tanaka, N.; Yamaguchi, T.; Ohno, T.; Kazui, T.; Ohori, K.; Kitano, I.; Abe, T.; Komatsu, S.; Wada, J.
Nihon Kyobu Geka Gakkai 31(2): 152-160
1983
ISSN/ISBN: 0369-4739 PMID: 6863999 Document Number: 216127
Cases (251) of aortic valve replacment (AVR) were isolated using 4 different types of prostheses [Starr-Edwards Type 1000, 1200 (SE) 106, Wada-Cutter (WC) 51, Smeloff-Cutter (SC) 61, Lillehei-Kaster (LK) 33] as well as 194 cases of mitral valve replacement (MVR) with 3 different types of prostheses [SE Type 6000, 6120 65, WC 60, Hancock (H) 69] were studied. There were 47 deaths in AVR (18.7%) and 34 deaths in MVR (17.5%) as early hospital mortality. The primary cause of early deaths was mainly due to postoperative low cardiac output syndrome in 32 of 47 mortalities (68.1%) in AVR and in 24 of 34 mortalities (70.6%) for MVR. Only the group of H valve have shown a significantly low early motality rate (10.1%) compared to the other group with different types of prostheses (P < 0.05). Long-term follow-up results showed that there were 57 late deaths in 202 cases of AVR (28.2%) in the average follow-up of 7.7 yr and 61 late deaths in 160 cases of MVR (38.1%) in average follow-up of 5.5 yr postoperatively. As to to valve related mortality, the groups with postoperative anticoagulant therapy have shown significant low late mortality rate [SC: 7 of 49 (14.3%), LK: 2 of 25 (8.0%)] than that without [WC: 20 of 40 (50%), SE: 30 of 88 (34.1%)] for AVR (P < 0.05). The same thing in MVR, the group with anticoagulant therapy demonstrated significant low mortality rate [H: 6 of 62 (9.7%)] than that without [WC:31 of 48 (64.6%), SE: 24 of 50 (48%)] (P < 0.05). However, when postoperative anticoagulant treatment was not instituted, the late mortality rates were not significantly different among the different types of prostheses both in AVR and MVR. Late mortality rate in valve replacement may be mainly dependent on the effect of postoperative anticoagulant therapy but on the type of cardiac prosthesis itself.