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Late outcome of patients with Braunwald-Cutter mitral valve replacement
Abstract:
Eighty patients who underwent mitral valve replacement (MVR) with Braunwald-Cutter prostheses (54, single valve replacement; 26, multiple valve replacement) between December, 1972, and September, 1975, are discussed. The period of follow-up ranged from 72 to 120 months with a mean of 84.6 months. For the hospital survivors, actuarial survival at ten years was 73 +/- 6.7% for patients with MVR alone and 30 +/- 17.5% for those with multiple valve replacement. The linearized rate of embolic complications in patients with MVR was 3.2% per year and in patients with multiple valve replacement, 1.5% per year. These low rates of embolism allow a favorable comparison of the Braunwald-Cutter valve with other mechanical prostheses. There was no evidence of serious poppet wear or poppet escape after ten years of the valve in the mitral and tricuspid positions. Thus, elective replacement of the Braunwald-Cutter valve from the atrioventricular position because of this potential problem is not considered necessary. In the aortic position, escape of the poppet from the valve has occurred as late as 101 months. The overall morbidity for the group was high. Only 34% of the patients having MVR and 12% of those with multiple valve replacement are expected to be alive and to remain free from any major complication ten years after operation.
Insights
The Braunwald-Cutter valve shows low embolic complication rates in mitral valve replacement (MVR) patients. Poppet wear is minimal in mitral/tricuspid positions, but poppet escape occurred in the aortic position.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- The Braunwald-Cutter valve was used for mitral valve replacement (MVR) between 1972 and 1975.
- Long-term outcomes and complications of this prosthesis were not fully established.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the Braunwald-Cutter valve in patients undergoing mitral valve replacement.
- To assess survival rates, embolic complications, and structural integrity of the prosthesis over a 10-year follow-up period.
Main Methods:
- Retrospective analysis of 80 patients who received Braunwald-Cutter prostheses for mitral valve replacement.
- Follow-up duration ranged from 72 to 120 months (mean 84.6 months).
- Actuarial survival, embolic complication rates, and valve structural integrity were analyzed.
Main Results:
- Ten-year actuarial survival was 73% for MVR alone and 30% for multiple valve replacement.
- Linearized embolic rates were 3.2%/year for MVR and 1.5%/year for multiple valve replacement.
- No significant poppet wear or escape observed in mitral/tricuspid positions after 10 years; poppet escape occurred in the aortic position up to 101 months.
Conclusions:
- The Braunwald-Cutter valve demonstrates favorable embolic complication rates, comparable to other mechanical prostheses.
- Elective replacement due to poppet wear/escape is unnecessary for mitral/tricuspid positions.
- High overall morbidity highlights the risks associated with valve replacement surgery.