Aortic valve replacement. A randomized study comparing Björk-Shiley and Lillehei-Kaster disc valves. Haematological...

In this study, 79 randomized patients with either Björk-Shiley (B-S) or Lillehei-Kaster (L-K) aortic disc valves were re-admitted two years after operation for clinical, haemodynamic and haematological evaluation. This paper deals in particular with the haematological results. Cine-aortography was carried out in 76 patients and left ventricular catheterization via the transseptal approach was performed in 43 patients. Haemoglobin concentration, erythrocyte count, platlet count, reticulocyte count, plasma haemoglobin concentration, serum bilirubin, serum iron, serum haptoglobin and serum lactate dehydrogenase were studied in the patients. Postoperatively all patients had normal haemoglobin and erythrocyte count. Haptoglobin was absent or reduced in 43% of patients with B-S valves and in 65% of those with L-K valves. Serum lactate dehydrogenase activity (LDH) was abnormally elevated in 26% of patients in the B-S group and in 65% of those in the L-K group. Mean LDH was significantly higher in the L-K group compared with the B-S group (p less than 0.01). A highly significant linear correlation could be demonstrated between mean systolic pressure difference across the valve (delta pm) and LDH (p less than 0.001). This finding helps to explain why the L-K valves provoke more erythrocyte destruction than the B-S valves, since delta pm proved to be significantly higher in the L-K group. LDH was not significantly increased in 6 patients in whom a paravalvular leakage was demonstrated.