Replacement of the aortic valve with the starredwards and sutureless (Magovern) prostheses

Abstract

Abstract 1.1. Data obtained in 35 patients, 25 male and 10 female, in whom postoperative catheterization studies on the aortic and ventricular side of the artificial valve were made 6 to 18 months following the replacement of a diseased aortic valve, have been reviewed. 2.2. The Starr-Edwards prosthesis was used in 17 patients, 11 male and 6 female. Eight of these patients had resting systolic gradients ranging between 15 and 50 mm. Hg. 3.3. The Magovern-Cromie valve was used in 18 patients, 14 male and 4 female. Only 3 had abnormal resting systolic gradients. These were 15, 25 and 35 mm. Hg, respectively. 4.4. While obstructing gradients over the aortic ball-valve prostheses are due to many factors, the presence or absence of gradients in either of these two groups of patients seemed primarily related to the proximity of the aortic wall to the artificial valve cage. The lack of gradients with the Magovern-Cromie valve appeared to result from the use of this valve when a small aortic annulus and poststenotic dilatation exist, therefore allowing extra room about the prosthesis. 5.5. Mild aortic insufficiency about the prosthetic rim was more common in the group in whom the Magovern-Cromie valve was used (5 of 18 cases) but was of no clinical significance in any patient in either group. 6.6. The important lesson from this study for surgeons is the following: In choosing a ballvalue prosthesis at the operating table it is far more important in obviating morbidity and mortality to select a smaller size and leave adequate outflow room between the cage and the aortic wall than to choose the reverse.