Experience With the Starr-Edwards Aortic Valve: Report of Sixty Cases

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THE Starr-Edwards aortic valve has been used at the Cleveland Clinic Hospital for the surgical treatment of acquired aortic valvular disease, for one and one-half years. The decision to utilize the Starr-Edwards aortic valve was influenced by two factors: (l) dissatisfaction with the late results of valvuloplasty, and (2) lack of confidence in the cloth type of prosthesis. This report reviews our experiences with the first 60 patients in each of whom the Starr-Edwards aortic valve was used for aortic valve replacement.

In 1956, we undertook the surgical treatment of acquired aortic valvular disease, utilizing the direct approach with extracorporeal circulation.1 Efforts were made to relieve calcific aortic stenosis by a combination of decortication and commissurotomy. Insufficiency of the aortic valve, related to dilatation, and prolapse of the redundant cusps were treated by various plastic procedures designed to reduce the caliber of the aortic root, and to reestablish cusp integrity—on occasion the aortic valve was rendered bicuspid. All of the procedures were undertaken with enthusiasm, and the initial results frequently were gratifying. However, evaluations of the long-term results have been uniformly disappointing: in our experience, calcified aortic valves, treated by decortication, invariably became recalcified and restenosed. Regurgitant valves treated by plication, plastic support, or bicuspidation, were not wholly satisfactory: the little-understood process that leads to cusp attenuation was not arrested, and insufficiency recurred. Our experience led us to the conclusion that plastic procedures designed for the relief of stenosis or of insufficiency were not of long-term value. For this . . .



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