Comparison of Three Devices to Replace the Aortic Valve

During a 15-month period, 278 operations for isolated aortic valve disease were performed using either a Braunwald-Cutter (BC) prosthesis, a Starr-Edwards composite-seat prosthesis (SE), or a homograft (H). No attempt was made to randomize cases. No anticoagulants were given postoperatively. Hospital mortality was 5%. The recent experience with prosthetic valves (BC and SE) was compared with a larger long-term experience for homografts. Embolism from homografts was negligible. The unanticoagulated prosthetic valves had a high incidence of thromboembolism (BC 10.7%, mean follow-up 6.8 months; SE 9.0%, mean follow-up 9.6 months). Mechanical performance seemed satisfactory in all devices at 1 year. However, at 5 years approximately 12% of patients with homografts had hemodynamically significant aortic insufficiency. Our experience to date indicates that the cloth-covered prosthesis in unanticoagulated patients is not a satisfactory substitute for a homograft valve.