Hemolysis in the aortic prosthetic valve.

A review of the incidence and severity of hemolysis in the aortic prosthesis is presented. The noncloth-covered Starr-Edwards prosthetic series 1000, 1200, and 1260 had a 2 percent (1/54) incidence of anemia. The cloth-covered Starr-Edwards aortic prosthetic series 2300 was associated with anemia in 61 percent (28/46) of patients. The modified aortic prosthetic series 2310 and 2320 had a 34 percent (19/56) incidence. Mean lactic dehydrogenase levels for the series 1000, 1200 and 1260 were 184 units; 2300 series, 574 units; 2310 and 2320 series, 334 units; and the Bjork-Shiley aortic prosthesis, 166 units. Nine patients underwent repeat surgery because of refractory anemia in the 2300 series, and one did so in the 2310 series. Four of the patients with repeat surgery had significant cloth wearing of the valve. A transvalvular gradient in excess of 30 mm Hg was present in seven of ten anemic patients studied who had the series-2300 valve. The cloth-covered Starr-Edwards aortic prosthesis carries a significant risk of anemia. At the present time the 2310 and 2320 series cause less hemolysis and a lower incidence of anemia than the original 2300 series but in excess of the noncloth-covered Starr-Edwards prosthesis.