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(Circulation. 1973;48:III-74.)
© 1973 American Heart Association, Inc.

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Postoperative Hemodynamic Evaluation of a New Fabric-Covered Ball-Valve Prosthesis

ROBERT A. O'ROURKE M.D.¹; KIRK L. PETERSON M.D.¹; NINA S. BRAUNWALD M.D.¹

¹ From the Departments of Surgery and Medicine, University of California, San Diego, California.

Previous in vitro and in vivo experimental studies have indicated that insertion of the Braun-wald-Cutter fabric-covered ball-valve prosthesis results in negligible thromboembolic complications and hemodynamic performance comparable to that of noncovered mitral and aortic ball-valve prostheses. To assess the clinical efficacy of this fabric-covered valve prosthesis, 35 patients have been followed for 4 to 26 months (540 patient-months) after mitral and/or aortic valve replacement, and 13 have had extensive hemodynamic re-evaluation.

In eight patients with the mitral valve prosthesis, the mean diastolic gradient averaged 4.8 mm Hg (range 0 to 8) and the end-diastolic gradient 0.8 mm Hg (range 0 to 2) at a time when the mean heart rate was 75 beats/min (range 50 to 100) and the cardiac output averaged 5.1 L/min (range 3.4 to 8.0). The calculated effective mitral valve orifice size averaged 2.68 cm² (range 1.92 to 3.46). In six patients with the aortic valve prosthesis, the average peak systolic gradient was 13 mm Hg (range 0 to 22), and the mean systolic gradient averaged 14.5 mm Hg (range 0 to 24) when the mean heart rate was 82 beats/min (range 64 to 120) and the cardiac output averaged 6.2 L/min (range 3.2 to 9.3). The average effective aortic valve size in the five patients with a mean systolic transvalvular gradient was 1.41 cm² (range 1.26 to 1.62).

Only one postoperative thromboembolic complication has been observed, and this occurred in a patient with atrial fibrillation and a large left atrium three weeks after discontinuing anticoagulant therapy because of gingival bleeding.

These data indicate that use of the fabric-covered Braunwald-Cutter ball prosthesis produces few thromboembolic complications and a satisfactory hemodynamic result.

Key Words: Anticoagulants • Thromboembolism • Prosthetic heart valves • Valve replacement