Aortic valve replacement with the Lillehei-Kaster prosthesis in 262 patients: an assessment after 9 to 17 years

A 9 to 17-year follow-up after aortic valve replacement with the Lillehei-Kaster prosthesis was carried out in 262 patients with a mean age of 53 years. All patients were traced. The operative mortality was 7.3%. The observed survival of the total series after 5, 10 and 15 years amounted to 75%, 61%, and 49% respectively. The majority of survivors showed improvement of functional capacity and decrease of heart volume. Freedom from valve-related death, thromboembolism and valve-related morbidity and mortality after 15 years amounted to 94%, 85% and 75% respectively. Only two instances of valve thrombosis were seen, and fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards and the Björk-Shiley prostheses. Analysis of the relative survival rates, i.e. the observed survival rates as ratios of those of the general population, indicates that the 10-year survival of patients with aortic stenosis is close to normal, whereas the survival rates of patients with aortic incompetence and with combined aortic stenosis and incompetence are significantly lower. It is suggested that earlier operation should be considered in patients with aortic incompetence and with combined stenosis and incompetence in order to lower the late mortality rate.