Late postoperative clinical and hemodynamic assessment of the early cloth-covered Starr-Edwards mitral valve prosthesis

Abstract

Despite large gradients at rest and exercise across the Model 6300 Starr-Edwards valve, patients in whom it has been inserted have generally had an improvement in functional class and a decrease in heart size; in addition, the heart usually has been successfully maintained in sinus rhythm. The clinical improvement observed in patients with mitral stenosis most probably is a result of an increase in orifice area to above the critically obstructive range, producing a rise in cardiac output. In patients with mitral insufficiency a relatively competent valve is provided; this also may engender an increase in cardiac output. Nevertheless, the calculated orifice area of this prosthetic valve indicates that it may produce a moderate-to-severe degree of obstruction to blood flow. Therefore, in significantly symptomatic patients, replacement of this less than ideal prosthesis should be considered.