Long term survival without anticoagulation after aortic valve replacement with a Lillehei-Kaster prosthesis. A case report.

A patient who underwent aortic valve replacement with a Lillehei-Kaster prosthesis developed an early duodenal ulcer requiring suspension of warfarin treatment. Subsequently he was managed without oral anticoagulants, receiving only antiplatelet agents, starting from the third postoperative year. Neither thromboembolic nor hemorrhagic complications occurred but at reoperation, performed almost 20 years later for prosthetic stenosis caused by a fibrous ring, and aneurysm of the ascending aorta, mild fresh thrombus was found on the prosthetic ring. Although the long term outcome of patients with a mechanical aortic prosthesis can occasionally be successful even without long term anticoagulation, such management appears to be justified only in highly selected cases.