Structural Valve Deterioration in a Starr-Edwards Mitral Caged-Disk Valve Prosthesis

• Published in: Circulation Journal Vol. 77; no. 1; pp. 105 - 108
• Main Authors: Aoyagi, Shigeaki, Tayama, Kei-ichiro, Okazaki, Teiji, Shintani, Yusuke, Kono, Michitaka, Wada, Kumiko, Kosuga, Ken-ichi, Mori, Ryusuke, Tanaka, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2013
• Subjects: Aged; Caged-disk valve; Disk fracture; Disk wear; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Mitral Valve - surgery; Prosthesis Failure; Prosthetic heart valve; Structural valve deterioration; Time Factors
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-12-0906

Background: The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known, and structural valve deterioration in the SE disk valve is very rare. Methods and Results: Replacement of the SE mitral disk valve was performed in 7 patients 23–40 years after implantation. Macroscopic examination of the removed disk valves showed no structural abnormalities in 3 patients, in whom the disk valves were removed at <26 years after implantation. Localized disk wear was found at the sites where the disk abutted the struts of the cage, in disk valves excised >36 years after implantation in 4 patients. Disk fracture, a longitudinal split in the disk along its circumference at the site of incorporation of the titanium ring, was detected in the valves removed 36 and 40 years after implantation, respectively, and many cracks were also observed on the outflow aspect of the disk removed 40 years after implantation. Conclusions: Disk fracture and localized disk wear were found in the SE mitral disk valves implanted >36 years previously. The present results suggest that SE mitral caged-disk valves implanted >20 years previously should be carefully followed up, and that those implanted >30 years previously should be electively replaced with modern prosthetic valves.  (Circ J 2013; 77: 105–108)