Systemic Thromboembolism in Mitral and Aortic Starr-Edwards Prostheses

Our study comprised 302 consecutive patients seen between 1962 and 1971 who underwent mitral (MVR) (132 patients) or aortic valve replacement (AVR) (170 patients) with a Starr-Edwards prosthesis because of advanced mitral or aortic incompetence. The follow-up interval was 10-19 years. For more recent valve models (1200/1260 aortic or 6120/6310 mitral), the probability of a surviving patient remaining free of systemic thromboembolism after 10 years was 70% for MVR and 74% for AVR. The probability offreedom from thromboembolism was less than this for the earlier valve models; the probability for the entire group at 10 years was 66% and at 15 years was 58%, with no significant difference between AVR and MVR. About one-fourth of the patients with an embolism (20% MVR, 27% AVR) had more than one embolic event. Of all emboli, most (86% MVR, 84% AVR) were cerebral, about half (48% MVR, 57% AVR) left a neurologic deficit, and about one-tenth (11% MVR, 10% AVR) led to death. Of the predictive factors reviewed, the incidence of emboli was significantly higher only in patients with MVR considered to have inadequate anticoagulation (p < 0.01) and in patients receiving model 6000 mitral prosthesis (p < 0.O₂). This long-term follow-up study of patients with a Starr-Edwards prosthesis reveals that systemic embolism is a persistent and significant problem.