Mid-term results of valve replacement with the ATS valve: a seven-year follow up.

BACKGROUND AND AIM OF THE STUDY: The ATS open pivot bileaflet valve has been the prosthesis of choice at the authors' hospital since 1997. Herein is presented a retrospective analysis of the mid-term results of valve replacement with the ATS valve prosthesis.

METHODS

Between 1997 and 2005, a total of 280 patients (mean age 58.3 years) underwent valve replacement with the ATS valve; these included 133 aortic valve replacements (AVR), 115 mitral valve replacements (MVR), and 32 double (aortic plus mitral) valve replacements (DVR). Preoperatively, 162 patients (57.9%) were in NYHA functional class II, 97 (34.6%) in class III, 19 (6.8%) in class IV, and two (0.7%) in class V. Atrial fibrillation was detected in 105 patients (37.5%), and significant coronary artery disease was found concomitantly in 13 (4.6%). Postoperative anticoagulant therapy consisting of warfarin and an antiplatelet drug was usually instituted on the first postoperative day, and the International Normalized Ratio maintained between 1.6 and 2.5.

RESULTS

Overall hospital mortality was 3.6% (n = 10). Hospital survivors were followed for a mean period of 4.2 years (maximum 10 years); the total follow up was 1,127.9 patient-years (pt-yr). Follow up was complete for 267 patients (98.9%). Actuarial survival at seven years was 87.1% for AVR, 79.8% for MVR, and 90.1% for DVR. The probability of freedom from valve-related death at seven years was 96.7% for AVR, 94.4% for MVR, and 100% for DVR. The linearized rates for postoperative complications were thromboembolism 1.2%/pt-yr, major bleeding 0.7%/pt-yr, prosthetic valve endocarditis 0.2%/pt-yr, non-structural dysfunction 0.7%/pt-yr, and reoperation 0.5%/pt-yr. Structural valve failure was not encountered.

CONCLUSION

This clinical experience with the ATS open pivot heart valve demonstrated low rates of adverse events and valve-related complications.