Aortic valve replacement in elderly patients.

During the years 1965--75, 98 patients more than 65 years of age had aortic valve replacement in our hospital, 24 ball valves and 74 disc valves inserted in their aortic orifice. Actuarial analysis of survival in these patients shows that the operative risk is slightly higher in elder than in younger patients. The survival curve for the following years for those who had disc valve implantation runs parallel to that of younger patients, while those who had ball valve implantation showed a more rapid fall in survival after 3 years. After 10 years, only 30% of patients with ball valve transplantation were alive.

Prevention of arterial thromboembolism with acetylsalicylic acid. A controlled clinical study in patients with aortic ball valves.

Prevention of arterial thromboembolism with acetylsalicylic acid (ASA) was studied in 148 patients with single Starr-Edwards aortic ball-valve prostheses. These patients are suitable for such a study because they have a high incidence of arterial emboli derived mainly from thrombi formed on the valves. They were given either 1 Gm. of ASA daily or placebo in combination with anticoagulants, and were observed for 2 years. Only two emboli occurred in patients receiving ASA, none of them severe. In the placebo group 12 thromboembolic episodes were diagnosed in 10 patients, and three with cerebral emboli died; in one a subdural hematoma unrelated to the embolus was found. In addition, one fatal and the one nonfatal intracranial bleeding occurred in each group, whereas gastrointestinal complications were seen more frequently in patients taking ASA. It is concluded that ASA combined with anticoagulants offered a significantly better protection against arterial thromboembolism than did anticoagulant therapy alone.

Long-term shunt palliation for Fallot's tetralogy.

One hundred and sixty-two systemic-pulmonary shunts of various types were performed in 136 patients with Fallot's tetralogy. There were 72 Blalock-Taussig shunts, 31 Potts and 24 of Waterston shunts. Furthermore, systemic-pulmonary anastomoses with interposed grafts were made in 34 cases. The patients were followed up for 1 to 23 years, average 12 1/2 years. The total mortality varied from 25% in the Waterston group to 42% in the Potts group. The immediate palliative effect of the shunt operation in the surviving patients seemed to be independent of the type of shunt used. At follow-up, 9 of 69 patients originally operated upon with a Blalock-Taussig shunt were alive with their original shunt, while the corresponding figure in the Potts group was 12 of 30. More than 20 years after palliation, one of 15 patients were alive with an original Blalock-Taussig shunt and 9 of 22 with a Potts anastomosis. Surgical problems in construction of the shunts and the long-term results are briefly discussed.