Thirteen year-experience with mitral valve replacement.

At the Niigata University Hospital, various kinds of prosthetic valves such as the Starr-Edwards nonclothand cloth-covered, Bjork-Shiley tilting disc, and Carpentier-Edwards porcine valves, have been used from September, 1965 to March, 1979 for replacement of diseased valves on 176 patients. The patients with Starr-Edwards nonclothand cloth-covered ball valves showed survival rates of 90 and 84% over a period of 5 years, and 87 and 81% for 8 years. Those with Carpentier-Edwards porcine and Bjork-Shiley tilting disc valves exhibited a survival rate of 93% for 1 and 3 years respectively. Since 1973, regarding postoperative thromboembolic complications, patients who could not be maintained within a suitable therapeutic range using Warfarin, were given Bucolome also. For the patients with the Starr-Edwards cloth-covered valve, the 6-year major thromboembolismfree rate was 92% in those operated before 1973 and 96% for those operated since 1973. The minor episodes were free in 85 and 100%, respectively. The actuarial reoperation rate at 7 years was 7% for the patients with Starr-Edwards noncloth-covered and 1% for those with cloth-covered valves. However, there was only one death among 7 patients. No reoperation was carried out for the other valves. In conclusion, the actuarial survival curve for the Starr-Edwards ball valves showed a good survival rate when the patients age at the operation was taken into account. The use of the Bjork-Shiley tilting disc and Carpentier-Edwards porcine valves is also justified within the constraint of the short follow-up period.