DeBakey-surgitool pyrolite® aortic valve: results of isolated replacement in 345 patients followed up to 13 years after operation

Summary

The clinical and hemodynamic outcome of isolated aortic valve replacement with the DeBakey-Surgitool Pyrolite® aortic valve prosthesis was evaluated in 345 consecutive patients operated on between 1968 and 1978 and followed up to 17 years after operation. Their mean age was 47.8 ± 15.8 years. The perioperative mortality rate was 8.1%. Five-year survival probability (Kaplan-Meier) was 74.0%.

Preoperatively, 53.0% of patients were in New York Heart Association (NYHA) Class III-IV, but postoperatively only 9.9% were in Class III-IV. The overall annual rate of thromboembolism was 2.9%, but for patients maintained on Coumadin® it was 1.7%. In this study, aspirin and Persantine® provided no protection against thromboembolism. Other complications were relatively infrequent, and 5 years after operation the probability of freedom from all major complications was 81.8%.

Follow-up catheterization was performed on 27 patients at a mean interval of 57.7 months (range, 3–146 months). Whereas the preoperative aortic valve gradient was 56.1 ± 49.6 mm Hg (range, 0–165 mm Hg), the prosthetic valve gradient was 4.7 ± 10 mm Hg (range, 0–50 mm Hg). There was no measurable gradient in 19 patients. Three patients had strut fracture at the site of attachment of the titanium cage to the annulus. This problem is rare and has been rectified by changes in the construction of the cage. With the exception of these mechanical failures, the results obtained with this prosthesis compare favorably with other mechanical aortic valve prostheses.

Supported in part by HEW research grant HL-17269, National Heart and Blood Vessel Research and Demonstration Center, Houston, Texas