Forty years Starr Edwards aortic prosthesis: A clinical follow-up

Objectives: Retrospective, long-term review of patients with isolated aortic valve replacement with the Starr-Edwards prosthesis.

Material and Methods: A total of 286 patients, mean age 40.1±10.1 years (14–62 years) had aortic valve replacement between 1963 and 1977 with different types of the Starr Edwards prosthesis. The majority of patients were in NYHA class III. Phenprocoumon was routinely administered from the early 80ies in all. Early mortality was 17.1%. Follow-up was completed for 203/237 operative survivors (86.1%), representing 2749 patient years (pt-y).

Results: Mean follow-up was 11.1±10.4 (0.5–39) years. Actuarial long-term survival was 62.3%, 39.4%, 19.9% and 12.2% after 10, 20 30 and 35 years; median survival was 15.6 years. Sixty-one (21.3%) patients died due to aortic valve-related complications. Thromboembolic and anticoagulation related complications were observed in 1.35%/pt-y and 1.02%/pt-y. Endocarditis was diagnosed in 8 patients, 34 patients were reoperated (1.24%/pt-y; average interval to reoperation 8.9 years). Actuarial freedom from valve reoperation was 85.8%, 80.2%, 62.3% and 62.3% after 10, 20, 30 and 35 years. Actuarial freedom from all complications, reoperations, and valve-related deaths was 66.4% at 10 years, 43.3% at 20 years, 23.8% at 30 years and 15.8% at 35 years. At the time of follow-up, 52 (18.2%) patients were alive, 35 (12.2%) with their original prosthesis (all patients in NYHA I or II, longest survival with the original prosthesis 35 years).

Conclusions: The Starr-Edwards aortic valve has demonstrated excellent long-term durability in vivo with good life quality and acceptable complication rates.