Long-term results of the cloth-covered Starr-Edwards ball valve

Between June 1968 and March 1977, Starr-Edwards cloth-covered ball valves were exclusively implanted, in a total of 74 patients at our institution, on a routine basis.

The retrospective postoperative follow-up rate was 84.5%, for up to 36 years in mitral valve patients (982.5 patient-years); and 81.3%, for up to 34 years in aortic valve patients (282.0 patient-years). Among 66 operative survivors, 20 patients required reoperation due to valve-related complications. Mortality and morbidity after valve replacement was reviewed, and excised valves were examined.

Survival rates after 10, 20, and 30 years were 74.6%, 64.1%, and 31.2%, respectively, after mitral valve replacement, and 62.5%, 50.0%, and 43.8%, respectively, after aortic valve replacement. Freedom from all valve-related complications, respectively after 10, 20, and 30 years, was 70.5%, 55.9%, and 46.4% after mitral valve replacement, and 56.2%, 37.5%, and 31.2% after aortic valve replacement. Cloth wear or pannus overgrowth was observed in all excised prostheses. Remarkable orifice tear was observed in mitral valves that were more than 20 years old. Pannus overgrowth on the studs contributed to prosthetic regurgitation in the older valves. Concomitant valve procedures were frequently required for valve-related complications or other aggravated valve lesions in the mitral position during the follow-up period.

Early diagnosis of valve dysfunction and the decision to reoperate are important to improve the long-term results for surviving patients who have received a cloth-covered Starr-Edwards valve, especially in the mitral position.