Ball valve (smeloff-cutter) aortic valve replacement without anticoagulation

• Published in: The Annals of thoracic surgery Vol. 60; no. 5; pp. 1312 - 1316
• Main Authors: Gometza, Begonia, Duran, Carlos M.G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.1995
• Subjects: Actuarial Analysis; Adolescent; Adult; Anticoagulants - administration & dosage; Aortic Valve Insufficiency - drug therapy; Aortic Valve Insufficiency - surgery; Aspirin - administration & dosage; Child; Dipyridamole - administration & dosage; Drug Therapy, Combination; Female; Follow-Up Studies; Heart Valve Prosthesis - mortality; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Retrospective Studies; Survival Analysis
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(95)00757-C

Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution of aortic valve replacement in selected patients without permanent anticoagulation therapy. 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. 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. Aortic valve replacement with the Smelloff-Cutter ball valve might be a valid alternative for young patients unable to maintain regular anticoagulation.