Clinical Experience with the Hall Pivoting Disk Valve

Summary

One hundred seventy-two patients have had Medtronic-Hall pivoting disk valves implanted at the University of North Carolina since April, 1978 as a primary procedure or in combination with other cardiac surgery. One hundred twenty-three patients (31 combined) had aortic valves implanted, 32 patients (3 combined) had mitral valves implanted, and 17 patients (7 combined) had aortic and mitral valves implanted. The actuarial survival at 4 1/2 years, excluding the operative mortality, is 100% for all patients with mitral valve replacement and 91 % for all patients with aortic valve replacement. The actuarial survival at 2 1/2 years for all patients with aortic and mitral valves replaced is 88%.

None of the patients had clinical evidence of hemolysis. The average LDH value was 531 ± 240 IU/L. Eighty percent of the surviving patients were totally asymptomatic, 19% were symptomatic with moderate exertion, and only 1 % were unchanged or worse.

Four cerebrovascular accidents occurred in this group of patients for a 1.1/100 patient years incidence of cerebrovascular accidents in the aortic group and a 3.8/100 patient years incidence in the mitral group. Two of the mitral valves were replaced because of thrombosis and one aortic valve was found to be thrombosed at autopsy in a late death for an incidence of 0.6/100 patient years in the aortic group and 3.8/100 patient years in the mitral group. Hemodynamic measurements performed intraoperatively showed that only the smallest valve size, #21, was somewhat stenotic, with the average valve area being 1.3 cm² for that size. There were no structural valve failures observed in this group of patients.