Comparative analysis of the Starr-Edwards ball valve, the Kay-Suzuki disc valve and transplant valves in the surgical correction of aortic valve disease

Abstract

There were 210 aortic valvular replacements between January 1964 and January 1968 consisting of 125 Starr-Edwards ball valves, 74 Kay-Suzuki disc valves, and 11 transplant valves. The overall operative mortality was 3.8 percent (8 deaths). The overall late mortality was 9.6 percent (12 deaths) for the ball valves, 1.3 percent (1 death) from syphilis affecting the central nervous system for the disc valves and one death from suicide in the transplant group. The patients with Starr-Edwards ball valves had a higher occurrence of thromboembolism (12 percent) than noted with the Kay-Suzuki disc valve (7 percent). Seven percent of the patients in the ball valve series developed coronary ostial obstruction from detached thrombi, whereas this complication did not occur in the patients with disc valves. Thromboembolism did not occur in the series of patients with transplant valves. The incidence of postoperative regurgitation was the highest with the transplant valves and the least with the Kay-Suzuki disc valve. Postoperative physiologic studies correlating type of valve, valve size, frustum area and cardiac output with pressure gradient and left ventricular end-diastolic pressure at rest and with exercise were performed one to three years after surgery. The transplant valves gave the best hemodynamic response, being slightly better than the Kay-Suzuki disc valves. The results noted with the Starr-Edwards valves were excellent in those sizes with the larger frustum areas when well placed within an enlarged aortic root, but the valves were restrictive to flow with a pressure differential over the prosthesis when they were situated in small aortic roots or where anatomic variations produced angulation of the valve.