Thrombotic phenomena with nonanticoagulated, composite-strut aortic prostheses

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science

Background:

• Aortic valve replacement with mechanical prostheses necessitates careful management.
• The Starr-Edwards Model 2400 is a specific type of mechanical aortic valve prosthesis.
• Anticoagulant therapy is a common consideration after mechanical valve implantation.

Purpose of the Study:

• To evaluate the long-term outcomes of patients with Starr-Edwards Model 2400 aortic valve prostheses who did not receive anticoagulant therapy.
• To assess the functional status of the prosthesis and identify complications in this patient group.

Main Methods:

• Hemodynamic studies including cardiac catheterization were performed on a subset of patients.
• Prostheses were examined at reoperation or autopsy for pannus and thrombus formation.
• Clinical follow-up included monitoring for mortality, embolic episodes, and overall patient status.

Main Results:

• Thirteen of 18 patients studied had critically stenotic valve orifices due to pannus and thrombus.
• Cardiac catheterization was the most reliable method for evaluating prosthetic function.
• Patients not on anticoagulation experienced significant complications, including death and embolic events.

Conclusions:

• Close follow-up, including cardiac catheterization, is essential for patients with Starr-Edwards Model 2400 aortic valve prostheses without anticoagulation.
• Long-term anticoagulation with sodium warfarin is indicated for all patients with this prosthesis, barring contraindications.