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Clinical experience with the Smeloff-Cutter prosthesis: 1- to 12-year follow-up
Insights
Long-term follow-up of aortic valve replacement with the Smeloff-Cutter prosthesis shows good functional improvement and survival. Anticoagulation with sodium warfarin reduced thromboembolism but increased bleeding risk.
Area of Science:
- Cardiovascular Surgery
- Prosthetic Heart Valves
- Clinical Outcomes
Background:
- The Smeloff-Cutter prosthesis was used for aortic valve replacement.
- Long-term outcomes of this specific prosthesis require evaluation.
Purpose of the Study:
- To assess the long-term results of aortic valve replacement using the Smeloff-Cutter prosthesis.
- To evaluate survival, functional status, and complications in patients receiving this prosthetic valve.
Main Methods:
- A retrospective study of 459 consecutive patients undergoing aortic valve replacement with the Smeloff-Cutter prosthesis.
- Follow-up ranged from 1 to 12 years postoperatively.
- Data collected included patient demographics, preoperative functional class, surgical procedures, mortality, functional status, and complications such as thromboembolism and bleeding.
Main Results:
- Operative mortality was 8.5%.
- 82% of survivors improved to New York Heart Association Class I.
- Actuarial survival was 80% at 5 years and 71% at 8 years.
- Thromboembolism incidence varied by anticoagulation: 5.4 per 100 patient-years without anticoagulants, 2.9 with antiplatelet agents, and 2.6 with sodium warfarin.
- Sodium warfarin reduced thromboembolism but was associated with significant bleeding morbidity.
Conclusions:
- Aortic valve replacement with the Smeloff-Cutter prosthesis can achieve good long-term functional improvement and survival.
- Careful consideration of anticoagulation is necessary to balance the risks of thromboembolism and bleeding.
Abstract:
To determine the long-term results of aortic valve replacement with the Smeloff-Cutter prosthesis, the fate of 358 of 459 (78%) consecutive patients was determined 1 to 12 years postoperatively. There were 319 male patients (70%). Mean age at operation was 57 years (range, 15 to 84 years). Aortic stenosis was the dominant lesion in 267 patients (58%) and aortic regurgitation in 133 patients (29%). Fifty-nine patients (13%) had both aortic stenosis and regurgitation. In addition to aortic valve replacement, 93 patients (20%) had coronary artery bypass, 30 (6.5%) had mitral commissurotomy, 23 (5%) had mitral valve replacement, and 41 (9%) had other procedures. Preoperative status by New York Heart Association Functional Class was: Class I, 3 (1%); Class II, 39 (8%); Class III, 148 (32%); and Class IV, 269 (59%). Operative (30-day) mortality was 8.5% (39 out of 459). Functional improvement was obtained in all postoperative survivors: 345 (82%), Class I; 63 (15%), Class II; and 12 (3%), Class III. A perivalvular leak developed in 6 patients (1%) and subacute bacterial endocarditis in five (1%). Actuarial long-term survival was 80% at 5 years and 71% at 8 years. Thromboembolism occurred in 34 patients (9.5%). The incidence of thromboembolism per 100 patient-years for patients receiving no anticoagulants was 5.4; antiplatelet agents, 2.9; and Coumadin (sodium warfarin), 2.6. Major thromboembolism was uncommon in patients on a regimen of sodium warfarin but major morbidity from bleeding was significant.