BALL VALVE (SMELOFF-CUTTER) AORTIC-VALVE REPLACEMENT WITHOUT ANTICOAGULATION

Background. Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution for aortic valve replacement in selected patie nts without permanent anticoagulation therapy. Methods. The availabili ty of a satisfactory follow-up system since July 1988 suggested a stud y of all 47 patients operated on since then and followed for a mean of 43.2 months (range, 16 to 78 months). Mean age was 26.3 years, 98% we re in sinus rhythm, and 16 patients (34%) had concomitant mitral repai r. Results. There were no hospital deaths. Three patients were lost to follow-up at a mean of 27 months. Four late deaths occurred (8.5%), t wo of them sudden, with actuarial survival at 6 years of 91% +/- 4.3%. There were a total of five embolic events (2.9%/patient-year) For iso lated aortic valve replacement only, with antiaggregant therapy (n = 2 9), the incidence was 0.9%/patient-year. For all patients receiving an tiaggregant agents (n = 43), it was 3.02%/patient-year. There were no known cases of valve thrombosis. Reoperation was required in 5 patient s. Conclusion. Aortic valve replacement with the Smeloff-Cutter ball v alve might be a valid alternative for young patients unable to maintai n regular anticoagulation.