Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Starr–Edwards aortic valve: 50+ years and still going strong: a case report

Starr–Edwards aortic valve: 50+ years and still going strong: a case report CASE REPORT European Heart Journal - Case Reports (2017) 1, 1–3 doi:10.1093/ehjcr/ytx014 Starr–Edwards aortic valve: 501 years and still going strong: a case report 1 2 1 1 Mourad Amrane , Gilles Soulat , Alain Carpentier , and Je´roˆme Jouan * 1 2 Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cite ´ , 75015 Paris, France; and Department of Radiology, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cite ´ , 75015 Paris, France Received 6 September 2017; accepted 26 October 2017; online publish-ahead-of-print 20 December 2017 Abstract The advent of the Starr–Edwards mechanical valve marked the beginning of the modern era for heart valve replace- ment. Nowadays, this valve has been supplanted by lower profile bileaflet mechanical prostheses that are con- sidered to have better haemodynamics, lesser risk of thrombo-embolic complications, and longer durability without structural prosthesis failure. These assumptions often lead physicians to face with the question of systematically replacing functional Starr–Edwards valves in patients undergoing redo operations on other valves. We report the case of a 67-year-old patient who recently underwent mitral valve replacement for symptomatic rheumatic valve disease with an excellent outcome. During the operation, the Starr–Edwards valve in the aortic position implanted 51 years earlier was found to still functioning normally hence was left in place, thereby breaking a new longevity re- cord for a valve prosthesis. Keywords Case report Mechanical heart valve prosthesis Long-term results Redo surgery � � � . 1 . position. It was the first valvular prosthesis produced and mar- . keted on a large scale. Its long-term results up to 40 years have . made the Starr–Edwards prosthetic valve a benchmark in the field Learning points . 2,3 of valvular surgery. However, if reoperation rates were A new longevity record beyond 50 years for valve prostheses reported similar to those of other more recent mechanical valves has been set by the caged-ball mechanical Starr–Edwards aor- with regard to infection and prosthetic valve dehiscence, it has been frequently stated that the Starr–Edwards valves had a higher tic valve. This landmark should contribute to reassure phys- risk of thrombo-embolic events and of valve dysfunction. In fact, icians and patients on the excellent performance of this valve. • . freedom from thrombo-embolic events after the implantation of Systematic replacement of Starr–Edwards aortic valve when Starr–Edwards valve in the aortic position varied from 74% to reoperating patients on mitral and/or tricuspid valve is not 87% at 10 years depending mainly on the time frame of the studies, mandatory. . 4,5 which likely reflected evolutions in anticoagulation protocols. Furthermore, in the most recent series, haemolysis and valve thrombosis rates were reported as low as 0.10% and 0.06% per patient years, respectively. We report a case of a 67-year-old Introduction patient who was recently reoperated on for rheumatic mitral and The caged-ball valve created by Albert Starr and Lowell Edwards tricuspid valve disease and had a Starr–Edwards aortic valve was implanted for the first time in September 1960 in the mitral implanted 51 years earlier with no valve dysfunction. * Corresponding author. Tel: þ33 156092060, Fax: þ33 156093604, Email: jouanjerome@hotmail.com. This case report was reviewed by Georg Goliasch and Timothy C. Tan. V The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018 2 M. Amrane et al. Timeline Year Event ................................................................................................. . 1965 Aortic valve replacement with a Magovern mechanical prosthesis for rheumatic valve disease 1966 Second cardiac procedure: aortic valve replacement with a Starr–Edwards 8A caged-ball prosthesis for Magovern valve dehiscence 1969 Third cardiac procedure: reinsertion of the Starr–Edwards aortic valve for partial prosthesis dehiscence and systematic ball replacement 2009 Atrial fibrillation and ischaemic stroke with aphasia. Complete clinical recovery within 3 months 2016 Hospitalization for pulmonary oedema revealing severe Figure 1 Preoperative Transthoracic Echocardiography: rheumatic mitral valve insufficiency continuous-wave Doppler evaluation of the Starr–Edwards aortic 2017 Fourth cardiac procedure: mitral valve replacement with a . prosthesis. Carbomedics mechanical prosthesis associated with . tricuspid valve annuloplasty. The 51-year-old . Starr–Edwards aortic valve was let intact. . Case report In 1966, a 17-year-old patient underwent reoperation at Broussais hos- . pital for dehiscence and dysfunction of a Magovern valve prosthesis . implanted a year earlier for rheumatic aortic valvular disease. A Starr– Edwards Model 1200 prosthesis Size 8A was then implanted. Two years later, this patient had to be reoperated on for valve reinsertion and the silastic ball of the Starr–Edwards valve was also preventively changed. Over the following 50 years, she was maintained under Coumadin, had regular check-ups, and did not present any noticeable medical problems except for a permanent atrial fibrillation (AF) and an ischaemic stroke event in 2009 although the international normalized ratio (INR) was within the therapeutic window between 2.5 and 3.5. She completely recovered from the latter event within 3 days. Recently, at age 67, she became symptomatic with dyspnoea New York Heart Association (NYHA) Class III. Auscultation revealed a sys- tolic murmur at the mitral area. Transthoracic echocardiography showed severe mitral insufficiency associated with increased left ven- Figure 2 3D Computed Tomography imaging volume rendering tricular (LV) dysfunction (LV ejection fraction 42% and LV end-systolic reconstruction of a three-chamber view showing the normal func- diameter 48 mm). The mitral valve was extremely remodelled; the . tioning of the Starr–Edwards valve in the aortic position. chordae were short and thickened, responsible for a Type IIIa posterior leaflet dysfunction. The anterior leaflet was severely retracted (height . .. .. The decision was made to operate on her mitral valve. Oral antico- 22 mm) but also prolapsing at the level of A2 by lateral displacement of .. .. .. agulation was discontinued 5 days before surgery and relayed by marginal chordae. On the other hand, the Starr–Edwards aortic valve .. non-fractioned heparin when the INR was below 2.5. The interven- prosthesis was found to function well with a mean transaortic gradient . tion was performed by median sternotomy with the complete re- at 16.8 mmHg, peak velocity of 267 cm/s, effective orifice Area of . 2 . lease of LV adhesions. Transoesophageal echocardiography in the 1.33 cm , and no significant regurgitation (Figure 1). Moderate tricuspid . . operating room confirmed that the Starr valve was functioning nor- insufficiency (regurgitant orifice area 25 mm ) and mild pulmonary ar- . mally and reinforced our idea of preserving this valve (see terial hypertension (systolic pulmonary arterial pressure 48 mmHg) . Supplementary material online, Video S1 and S2). The extracorporeal were also noted. Finally, on preoperative computed tomography scan . circulation was carried out by central canulation under moderate assessment (Figure 2), an anomalous aortic origin of the circumflex ar- . hypothermia. After aortic clamping and anterograde cold blood tery originating from the right coronary sinus was detected. Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018 Starr–Edwards aortic valve 3 cardioplegia, the mitral valve was approached via the Sondergaard Conclusion groove. Analysis of the mitral lesions showed that the valve vas not The excellent durability of the Starr valve is further demonstrated by amenable to a repair procedure. A mitral valve replacement was then . this observation. This might allow having a conservative attitude re- performed with a Carbomedics N 29 mechanical prosthesis com- . garding these valves, which, in this case, has shortened the operative bined with a tricuspid annuloplasty by a Carpentier-Edwards Physio . time, thereby contributing to a good operative outcome. prosthetic ring N 30. The duration of the aortic cross-clamping was . 90 min. The postoperative care was uneventful, except for an episode . of transient oliguria and pulmonary congestion which was favourably . Supplementary material treated by diuretics and non-invasive ventilation. The patient was put back on oral anticoagulation with a new tar- Supplementary material is available at European Heart Journal - Case geted INR between 3 and 4. Postoperative echocardiographic assess- Reports online. ment of the Starr–Edwards aortic prosthesis showed no functional modification compared with preoperative evaluation (see . Acknowledgements Supplementary material online, Video S3). The patient was able to leave the hospital quickly and is still doing well 5 months after the The authors are grateful to Dr Philippe Menasche´and Dr Wasseem intervention. Borik for their editing contribution. . Consent: The authors confirm that written consent for submission . and publication of this case report including image(s) and associated Discussion text has been obtained from the patientinlinewithCOPEguidance. Since its introduction in 1960, more than 175 000 patients have Conflict of interest: A.C. is a scientific advisor at Edwards received the Starr–Edwards valve in the mitral, aortic, or tricuspid Lifesciences R&D. position. The case of our patient is, to the best of our knowledge, Author Contributions: M.A. compiled data and was involved in the first reported observation of a Starr–Edwards prosthetic valve writing the article. G.S. helped in editing figures. A.C. was involved in still functioning after 50 years. Only two valve-related complications . clinical and surgical management and article reviewing. J.J. contributed to occurred during the follow-up. The first was a reintervention for . clinical and surgical management, article writing, reviewing, and editing. valve dehiscence 2 years after its implantation. One can assume that . this complication was due to a technical cause and not to the Starr– . References Edwards valve itself, because the native annulus had suffered previous . . 1. Starr A, Edwards ML. Mitral replacement: clinical experience with a ball-valve damage from the dehiscence of the initial Magovern prosthesis. The . prosthesis. Ann Surg 1961;154:726–740. 2. Go ¨ dje OL, Fischlein T, Adelhard K, Nollert G, Klinner W, Reichart B. Thirty-year change of the silastic ball had been carried out systematically, but the . results of Starr-Edwards prostheses in the aortic and mitral position. Ann Thorac replaced ball did not present an abnormal infiltration pattern as Surg 1997;63:613–619. described for the model 1000. The second was an ischaemic stroke 3. Saxena P, Bonnichsen CR, Greason KL. Starr-Edwards aortic valve: forty-four years old and still working! J Thorac Cardiovasc Surg 2013;146:e21–e22. that occurred 43 years after implantation without any additional . 4. Orszulak TA, Schaff HV, Puga FJ, Danielson GK, Mullany CJ, Anderson BJ, Ilstrup image seen on the cardiac echography. Although thrombus from the DM. Event status of the Starr-Edwards aortic valve to 20 years: a benchmark for valve prosthesis cannot be definitively excluded as the cause of comparison. Ann Thorac Surg 1997;63:620–626. 5. Miller DC, Oyer PE, Mitchell RS, Stinson EB, Jamieson SW, Baldwin JC, Shumway stroke, the patient was also in AF. Contrary to a widely disseminated . NE. Performance characteristics of the Starr-Edwards model 1260 aortic valve belief, the rate of thrombo-embolic events in patients with Starr– prosthesis beyond ten years. J Thorac Cardiovasc Surg 1984;88:193–207. Edwards valves is not higher than that of patients with the latest gen- 6. Lund O, Pilegaard HK, Ilkjaer LB, Nielsen SL, Arildsen H, Albrechtsen OK. Performance profile of the Starr-Edwards aortic cloth covered valve, track valve, eration of valves regardless of the position. Fortunately, this event . and silastic ball valve. Eur J Cardiothorac Surg 1999;16:403–413. did not have any long-term neurological consequences for our pa- 7. Matthews AM. The development of the Starr-Edwards heart valve. Tex Heart Inst tient who fully recovered. The excellent haemodynamic stability of J 1998;25:282–293. . 8. Grunkemeier GL, Starr A. Late ball variance with the Model 1000 Starr-Edwards this valve reported in the literature as well as the aortic valve echo- aortic valve prosthesis. Risk analysis and strategy of operative management. cardiographic parameters led us to adopt a conservative attitude J Thorac Cardiovasc Surg 1986;91:918–923. on this aortic valve. Moreover, mitral valve exposure via the 9. Murday AJ, Hochstitzky A, Mansfield J, Miles J, Taylor B, Whitley E, Treasure T. . A prospective controlled trial of St. Jude versus Starr Edwards aortic and mitral Sondergaard groove was not limited by the aortic valve prosthesis valve prostheses. Ann Thorac Surg 2003;76:66–73. discussion 73–74. protrusion towards the left atrium. This allowed us to limit the surgi- . 10. John S, Ravikumar E, John CN, Bashi VV. 25-year experience with 456 combined cal time in a patient with an already significant ventricular dysfunction . mitral and aortic valve replacement for rheumatic heart disease. Ann Thorac Surg 2000;69:1167–1172. and thus to reduce the risk of excess mortality and complications in- . 11. Jones JM, O’Kane H, Gladstone DJ, Sarsam MA, Campalani G, MacGowan SW, 11 . herent in double mitral and aortic valve replacements. In view of . Cleland J, Cran GW. Repeat heart valve surgery: risk factors for operative mor- the need for anticoagulation treatment, we chose to implant a bileaf- . tality. J Thorac Cardiovasc Surg 2001;122:913–918. 12. Komeda M, David TE, Rao V, Sun Z, Weisel RD, Burns RJ. Late hemodynamic ef- let mechanical valve in the mitral position. Preservation of the poster- . fects of the preserved papillary muscles during mitral valve replacement. ior subvalvular apparatus during mitral valve replacement was . Circulation 1994;90:II190–II194. performed in a systematic manner for contributing to late improve- 13. Baumgartner H, Falk V, Bax JJ, De Bonis, M Hamm, C Holm, PJ Iung, B Lancellotti, P Lansac, E Mu~ noz, DR Rosenhek, R Sjo ¨ gren, J Tornos Mas, P ment of ventricular function as recommended by many authors and Vahanian, A Walther, T Wendler, O Windecker, S Zamorano, JL; ESC Scientific European Society of Cardiology/European Association for Cardio- . Document Group. 2017 ESC/EACTS guidelines for the management of valvular 12,13 Thoracic Surgery (ESC/EACTS) guidelines. heart disease. Eur Heart J 2017;38:2739–2791. Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal - Case Reports Oxford University Press

Starr–Edwards aortic valve: 50+ years and still going strong: a case report

Download PDF
3 pages

Loading next page...
 
/lp/oxford-university-press/starr-edwards-aortic-valve-50-years-and-still-going-strong-a-case-AM95iVV8su

References (14)

Publisher
Oxford University Press
Copyright
© The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology
eISSN
2514-2119
DOI
10.1093/ehjcr/ytx014
Publisher site
See Article on Publisher Site

Abstract

CASE REPORT European Heart Journal - Case Reports (2017) 1, 1–3 doi:10.1093/ehjcr/ytx014 Starr–Edwards aortic valve: 501 years and still going strong: a case report 1 2 1 1 Mourad Amrane , Gilles Soulat , Alain Carpentier , and Je´roˆme Jouan * 1 2 Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cite ´ , 75015 Paris, France; and Department of Radiology, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cite ´ , 75015 Paris, France Received 6 September 2017; accepted 26 October 2017; online publish-ahead-of-print 20 December 2017 Abstract The advent of the Starr–Edwards mechanical valve marked the beginning of the modern era for heart valve replace- ment. Nowadays, this valve has been supplanted by lower profile bileaflet mechanical prostheses that are con- sidered to have better haemodynamics, lesser risk of thrombo-embolic complications, and longer durability without structural prosthesis failure. These assumptions often lead physicians to face with the question of systematically replacing functional Starr–Edwards valves in patients undergoing redo operations on other valves. We report the case of a 67-year-old patient who recently underwent mitral valve replacement for symptomatic rheumatic valve disease with an excellent outcome. During the operation, the Starr–Edwards valve in the aortic position implanted 51 years earlier was found to still functioning normally hence was left in place, thereby breaking a new longevity re- cord for a valve prosthesis. Keywords Case report Mechanical heart valve prosthesis Long-term results Redo surgery � � � . 1 . position. It was the first valvular prosthesis produced and mar- . keted on a large scale. Its long-term results up to 40 years have . made the Starr–Edwards prosthetic valve a benchmark in the field Learning points . 2,3 of valvular surgery. However, if reoperation rates were A new longevity record beyond 50 years for valve prostheses reported similar to those of other more recent mechanical valves has been set by the caged-ball mechanical Starr–Edwards aor- with regard to infection and prosthetic valve dehiscence, it has been frequently stated that the Starr–Edwards valves had a higher tic valve. This landmark should contribute to reassure phys- risk of thrombo-embolic events and of valve dysfunction. In fact, icians and patients on the excellent performance of this valve. • . freedom from thrombo-embolic events after the implantation of Systematic replacement of Starr–Edwards aortic valve when Starr–Edwards valve in the aortic position varied from 74% to reoperating patients on mitral and/or tricuspid valve is not 87% at 10 years depending mainly on the time frame of the studies, mandatory. . 4,5 which likely reflected evolutions in anticoagulation protocols. Furthermore, in the most recent series, haemolysis and valve thrombosis rates were reported as low as 0.10% and 0.06% per patient years, respectively. We report a case of a 67-year-old Introduction patient who was recently reoperated on for rheumatic mitral and The caged-ball valve created by Albert Starr and Lowell Edwards tricuspid valve disease and had a Starr–Edwards aortic valve was implanted for the first time in September 1960 in the mitral implanted 51 years earlier with no valve dysfunction. * Corresponding author. Tel: þ33 156092060, Fax: þ33 156093604, Email: jouanjerome@hotmail.com. This case report was reviewed by Georg Goliasch and Timothy C. Tan. V The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018 2 M. Amrane et al. Timeline Year Event ................................................................................................. . 1965 Aortic valve replacement with a Magovern mechanical prosthesis for rheumatic valve disease 1966 Second cardiac procedure: aortic valve replacement with a Starr–Edwards 8A caged-ball prosthesis for Magovern valve dehiscence 1969 Third cardiac procedure: reinsertion of the Starr–Edwards aortic valve for partial prosthesis dehiscence and systematic ball replacement 2009 Atrial fibrillation and ischaemic stroke with aphasia. Complete clinical recovery within 3 months 2016 Hospitalization for pulmonary oedema revealing severe Figure 1 Preoperative Transthoracic Echocardiography: rheumatic mitral valve insufficiency continuous-wave Doppler evaluation of the Starr–Edwards aortic 2017 Fourth cardiac procedure: mitral valve replacement with a . prosthesis. Carbomedics mechanical prosthesis associated with . tricuspid valve annuloplasty. The 51-year-old . Starr–Edwards aortic valve was let intact. . Case report In 1966, a 17-year-old patient underwent reoperation at Broussais hos- . pital for dehiscence and dysfunction of a Magovern valve prosthesis . implanted a year earlier for rheumatic aortic valvular disease. A Starr– Edwards Model 1200 prosthesis Size 8A was then implanted. Two years later, this patient had to be reoperated on for valve reinsertion and the silastic ball of the Starr–Edwards valve was also preventively changed. Over the following 50 years, she was maintained under Coumadin, had regular check-ups, and did not present any noticeable medical problems except for a permanent atrial fibrillation (AF) and an ischaemic stroke event in 2009 although the international normalized ratio (INR) was within the therapeutic window between 2.5 and 3.5. She completely recovered from the latter event within 3 days. Recently, at age 67, she became symptomatic with dyspnoea New York Heart Association (NYHA) Class III. Auscultation revealed a sys- tolic murmur at the mitral area. Transthoracic echocardiography showed severe mitral insufficiency associated with increased left ven- Figure 2 3D Computed Tomography imaging volume rendering tricular (LV) dysfunction (LV ejection fraction 42% and LV end-systolic reconstruction of a three-chamber view showing the normal func- diameter 48 mm). The mitral valve was extremely remodelled; the . tioning of the Starr–Edwards valve in the aortic position. chordae were short and thickened, responsible for a Type IIIa posterior leaflet dysfunction. The anterior leaflet was severely retracted (height . .. .. The decision was made to operate on her mitral valve. Oral antico- 22 mm) but also prolapsing at the level of A2 by lateral displacement of .. .. .. agulation was discontinued 5 days before surgery and relayed by marginal chordae. On the other hand, the Starr–Edwards aortic valve .. non-fractioned heparin when the INR was below 2.5. The interven- prosthesis was found to function well with a mean transaortic gradient . tion was performed by median sternotomy with the complete re- at 16.8 mmHg, peak velocity of 267 cm/s, effective orifice Area of . 2 . lease of LV adhesions. Transoesophageal echocardiography in the 1.33 cm , and no significant regurgitation (Figure 1). Moderate tricuspid . . operating room confirmed that the Starr valve was functioning nor- insufficiency (regurgitant orifice area 25 mm ) and mild pulmonary ar- . mally and reinforced our idea of preserving this valve (see terial hypertension (systolic pulmonary arterial pressure 48 mmHg) . Supplementary material online, Video S1 and S2). The extracorporeal were also noted. Finally, on preoperative computed tomography scan . circulation was carried out by central canulation under moderate assessment (Figure 2), an anomalous aortic origin of the circumflex ar- . hypothermia. After aortic clamping and anterograde cold blood tery originating from the right coronary sinus was detected. Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018 Starr–Edwards aortic valve 3 cardioplegia, the mitral valve was approached via the Sondergaard Conclusion groove. Analysis of the mitral lesions showed that the valve vas not The excellent durability of the Starr valve is further demonstrated by amenable to a repair procedure. A mitral valve replacement was then . this observation. This might allow having a conservative attitude re- performed with a Carbomedics N 29 mechanical prosthesis com- . garding these valves, which, in this case, has shortened the operative bined with a tricuspid annuloplasty by a Carpentier-Edwards Physio . time, thereby contributing to a good operative outcome. prosthetic ring N 30. The duration of the aortic cross-clamping was . 90 min. The postoperative care was uneventful, except for an episode . of transient oliguria and pulmonary congestion which was favourably . Supplementary material treated by diuretics and non-invasive ventilation. The patient was put back on oral anticoagulation with a new tar- Supplementary material is available at European Heart Journal - Case geted INR between 3 and 4. Postoperative echocardiographic assess- Reports online. ment of the Starr–Edwards aortic prosthesis showed no functional modification compared with preoperative evaluation (see . Acknowledgements Supplementary material online, Video S3). The patient was able to leave the hospital quickly and is still doing well 5 months after the The authors are grateful to Dr Philippe Menasche´and Dr Wasseem intervention. Borik for their editing contribution. . Consent: The authors confirm that written consent for submission . and publication of this case report including image(s) and associated Discussion text has been obtained from the patientinlinewithCOPEguidance. Since its introduction in 1960, more than 175 000 patients have Conflict of interest: A.C. is a scientific advisor at Edwards received the Starr–Edwards valve in the mitral, aortic, or tricuspid Lifesciences R&D. position. The case of our patient is, to the best of our knowledge, Author Contributions: M.A. compiled data and was involved in the first reported observation of a Starr–Edwards prosthetic valve writing the article. G.S. helped in editing figures. A.C. was involved in still functioning after 50 years. Only two valve-related complications . clinical and surgical management and article reviewing. J.J. contributed to occurred during the follow-up. The first was a reintervention for . clinical and surgical management, article writing, reviewing, and editing. valve dehiscence 2 years after its implantation. One can assume that . this complication was due to a technical cause and not to the Starr– . References Edwards valve itself, because the native annulus had suffered previous . . 1. Starr A, Edwards ML. Mitral replacement: clinical experience with a ball-valve damage from the dehiscence of the initial Magovern prosthesis. The . prosthesis. Ann Surg 1961;154:726–740. 2. Go ¨ dje OL, Fischlein T, Adelhard K, Nollert G, Klinner W, Reichart B. Thirty-year change of the silastic ball had been carried out systematically, but the . results of Starr-Edwards prostheses in the aortic and mitral position. Ann Thorac replaced ball did not present an abnormal infiltration pattern as Surg 1997;63:613–619. described for the model 1000. The second was an ischaemic stroke 3. Saxena P, Bonnichsen CR, Greason KL. Starr-Edwards aortic valve: forty-four years old and still working! J Thorac Cardiovasc Surg 2013;146:e21–e22. that occurred 43 years after implantation without any additional . 4. Orszulak TA, Schaff HV, Puga FJ, Danielson GK, Mullany CJ, Anderson BJ, Ilstrup image seen on the cardiac echography. Although thrombus from the DM. Event status of the Starr-Edwards aortic valve to 20 years: a benchmark for valve prosthesis cannot be definitively excluded as the cause of comparison. Ann Thorac Surg 1997;63:620–626. 5. Miller DC, Oyer PE, Mitchell RS, Stinson EB, Jamieson SW, Baldwin JC, Shumway stroke, the patient was also in AF. Contrary to a widely disseminated . NE. Performance characteristics of the Starr-Edwards model 1260 aortic valve belief, the rate of thrombo-embolic events in patients with Starr– prosthesis beyond ten years. J Thorac Cardiovasc Surg 1984;88:193–207. Edwards valves is not higher than that of patients with the latest gen- 6. Lund O, Pilegaard HK, Ilkjaer LB, Nielsen SL, Arildsen H, Albrechtsen OK. Performance profile of the Starr-Edwards aortic cloth covered valve, track valve, eration of valves regardless of the position. Fortunately, this event . and silastic ball valve. Eur J Cardiothorac Surg 1999;16:403–413. did not have any long-term neurological consequences for our pa- 7. Matthews AM. The development of the Starr-Edwards heart valve. Tex Heart Inst tient who fully recovered. The excellent haemodynamic stability of J 1998;25:282–293. . 8. Grunkemeier GL, Starr A. Late ball variance with the Model 1000 Starr-Edwards this valve reported in the literature as well as the aortic valve echo- aortic valve prosthesis. Risk analysis and strategy of operative management. cardiographic parameters led us to adopt a conservative attitude J Thorac Cardiovasc Surg 1986;91:918–923. on this aortic valve. Moreover, mitral valve exposure via the 9. Murday AJ, Hochstitzky A, Mansfield J, Miles J, Taylor B, Whitley E, Treasure T. . A prospective controlled trial of St. Jude versus Starr Edwards aortic and mitral Sondergaard groove was not limited by the aortic valve prosthesis valve prostheses. Ann Thorac Surg 2003;76:66–73. discussion 73–74. protrusion towards the left atrium. This allowed us to limit the surgi- . 10. John S, Ravikumar E, John CN, Bashi VV. 25-year experience with 456 combined cal time in a patient with an already significant ventricular dysfunction . mitral and aortic valve replacement for rheumatic heart disease. Ann Thorac Surg 2000;69:1167–1172. and thus to reduce the risk of excess mortality and complications in- . 11. Jones JM, O’Kane H, Gladstone DJ, Sarsam MA, Campalani G, MacGowan SW, 11 . herent in double mitral and aortic valve replacements. In view of . Cleland J, Cran GW. Repeat heart valve surgery: risk factors for operative mor- the need for anticoagulation treatment, we chose to implant a bileaf- . tality. J Thorac Cardiovasc Surg 2001;122:913–918. 12. Komeda M, David TE, Rao V, Sun Z, Weisel RD, Burns RJ. Late hemodynamic ef- let mechanical valve in the mitral position. Preservation of the poster- . fects of the preserved papillary muscles during mitral valve replacement. ior subvalvular apparatus during mitral valve replacement was . Circulation 1994;90:II190–II194. performed in a systematic manner for contributing to late improve- 13. Baumgartner H, Falk V, Bax JJ, De Bonis, M Hamm, C Holm, PJ Iung, B Lancellotti, P Lansac, E Mu~ noz, DR Rosenhek, R Sjo ¨ gren, J Tornos Mas, P ment of ventricular function as recommended by many authors and Vahanian, A Walther, T Wendler, O Windecker, S Zamorano, JL; ESC Scientific European Society of Cardiology/European Association for Cardio- . Document Group. 2017 ESC/EACTS guidelines for the management of valvular 12,13 Thoracic Surgery (ESC/EACTS) guidelines. heart disease. Eur Heart J 2017;38:2739–2791. Downloaded from https://academic.oup.com/ehjcr/article-abstract/1/2/1/4769310 by Ed 'DeepDyve' Gillespie user on 10 April 2018

Journal

European Heart Journal - Case Reports – Oxford University Press

Published: Dec 1, 2017

There are no references for this article.