Prosthetic replacement of the mitral or aortic valves: A preliminary report on 111 cases

Abstract

Total replacement of the aortic or mitral valve with a ball and seat prosthesis was used in a consecutive series of 111 patients with a mortality rate of 13.5 per cent. In the first 22 operations, 7 deaths occurred (32%), whereas in the last 89 operations there were only 8 deaths (9%), indicating the improvement in surgical technic and management. The valves were inserted during temporary cardiopulmonary bypass under normothermic conditions, using 5% glucose in distilled water to prime the pump oxygenator, eliminating the need for fresh, heparinized blood. Ages of the patients ranged between 15 and 72 and 2 patients undergoing successful aortic valve replacement were more than 70 years of age. Embolic phenomena after operation occurred in 4 patients, 3 of whom had prosthetic mitral valves. One patient with an aortic replacement had thrombosis of the valve ring with occlusion of the left coronary ostium. Prophylactic anticoagulants were used in all recent mitral replacements, but not in aortic valve replacements. Surviving patients have been improved, and many are engaged in normal activity. At present, total valve replacement offers an effective means of treatment for advanced mitral and aortic valvular disease with a relatively low surgical risk.