Ball valve (smeloff-cutter) aortic valve replacement without anticoagulation

Background. Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution of aortic valve replacement in selected patients without permanent anticoagulation therapy. Methods. The availability of a satisfactory follow-up system since July 1988 suggested a study of all 47 patients operated on since then and followed for a mean of 43.2 months (range, 16 to 78 months). Mean age was 26.3 years, 98% were in sinus rhythm, and 16 patients (34%) had concomitant mitral repair. Results. There were no hospital deaths. Three patients were lost to follow-up at a mean of 27 months. Four late deaths occurred (8.5%), two of them sudden, with actuarial survival at 6 years of 91% ± 4.3%. There were a total of five embolic events (2.9%/patient-year). For isolated aortic valve replacement only, with antiaggregant therapy (n = 29), the incidence was 0.9%/patient-year. For all patients receiving antiaggregant agents (n = 43), it was 3.02%/patient-year. There were no known cases of valve thrombosis. Reoperation was required in 5 patients. Conclusions. Aortic valve replacement with the Smelloff-Cutter ball valve might be a valid alternative for young patients unable to maintain regular anticoagulation.