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A total of 546 patients with severe aortic stenosis (AS) were retrospectively reviewed to assess the efficacy of percutaneous transluminal valvuloplasty (PTV) and valve replacement (VR). Of these, 490 underwent VR between 1968 and 1986 (mean age 62±12 years, 71·7% were in NYHA class III or IV), 68·8% received mechanical prostheses, and in 11·8% a bypass graft was associated. The operative mortality was 6·9% (4% since 1983). The mean follow-up was 57·6 months. The actuarial survival rate was 77% at five years, 60% at 10 years, and 40% at 15 years. Over 70 years of age, operative mortality was 6·2% since 1983, and the actuarial survival rate was 67·5% at five years.From February 1986 to May 1987, PTV was attempted in 56 patients and was effective in 52 patients (mean age 79±5 years, 93% in Class III or IV). Immediate mortality was 7·1%. The morbidity was due to tamponade (1·8%), myocardial infarction (3·6%), vascular trauma (5·3%), or cerebrovascular accident (9%). Forty three patients were followed after PTV (mean value 4·2±3, range 1–14 months): 12 patients (28%) died and 46% were functionally improved in NYHA Class II. PTV significantly improved the aortic valve area as shown by haemodynamics (0·49–0·75 cm2 P<0·0001) and these findings were corroborated by Doppler study (0·46–0·70 cm2, P<0·001).In conclusion, this series shows that surgery provides satisfactory results in AS with a low mortality and good long-term results, even in the elderly. PTV is a new therapeutic approach that can be used if surgery is contraindicated, especially in very old patients. This method is still capable of improvement and, in the future, its definite risks and long-term results are to be assessed. [ABSTRACT FROM PUBLISHER]

Thromboembolism, valve thrombosis and haemorrhagic events have been compared in 356 Starr-Edwards (SE) 1260, 113 Björk-Shiley (BS), and 178 aortic bioprostheses operated upon between 1968 and 1982, and reviewed by the same group with less than 2% of patients lost of follow-up. Expressed in actuarial rate at 7 years the percentage of patients free of thromboembolism event is 87% for SE, 86% for BS. 94% for bioprostheses; the linearized rate is 2·9%/patient/year for SE, 2·2 for BS, 1·9 for bioprostheses (NS).Valve thrombosis was not observed in bioprostheses; 97·9% of patients with mechanical valves were free of valve thrombosis at 6·5 years.Haemorrhagic risk was lower with bioprostheses than with mechanical valves 0·2% patient/year vs 2·33 (P<0·005).The most important factor influencing thromboembolic and haemorrhagic risks is the quality of anticoagulant therapy. Other contributing factors are the date of the operation and associated mitral disease. [ABSTRACT FROM PUBLISHER]

Among 1436 patients who underwent valve replacement, the 400 first cases were studied to assess the features of recurrent systemic embolic event. The mean follow-up was 87 months. Three groups of patients were compared: group A — 289 patients without any thromboembolic event (72·25%); group B—78 patients with only one embolic event (19·5%); group C—33 patients with several embolic events (8·25%).The frequency of recurrence was high: one patient out oj three (linearized mean 8·9% in group C considering only one recurrence, vs 3·8% in group B). The recurrence have the same location in 45% of patients. The consequences of these embolisms are serious: each event has a 30 to 40% risk of death or major disability. Four variables seem statistically to promote the occurrence of embolic events: mitral prostheses, pre-operative fibrillation, left atrial enlargement, poor anticoagulant therapy. 54 months after the first embolic event, 60% of the patients with poor anticoagulant therapy experience a recurrent thromboembolism vs 20% with adequate therapy.Twenty-six patients of groups B and C had a pathological study of prostheses. Thrombosis of the prostheses was found in 12 out of 18 patients in group B and in 7 out of 8 patients; in group C.Strict observance of anticoagulant therapy is the better way to prevent thromboembolism and especially recurrences. A reoperation is sometimes necessary. Valve re-replacement was performed in 27 cases out of 1436 patients. [ABSTRACT FROM PUBLISHER]

Plasma beta-thromboglobulin (BTG) was measured in 132 patients with valvular heart disease: 43 were studied before, 89 after surgery (78 mechanical valves and 11 bioprostheses). In this group of 89 selected patients, a history of thromboembolism was present in 53 (5 of them had bioprosthesis).Some abnormalities have been observed in patients with valvular heart disease as compared with controls: decreased platelet count and retention on glass column, and increased BTG. There is no statistically significant difference in BTG level between patients with (m±SD: 62·4±42·0 ng ml−1), or without (59·5∓41·0ng ml−1) a prosthesis; in the small series of 11 patients with a bioprosthesis, BTG was slightly lower than in other patients (44·5 ± 14·1 ng ml−1), but still higher than in controls (26·8 ± 13·3 ng ml−1).In the patients with a history of thromboembolism, BTG was significantly higher (66·7±47·9 ng ml−1 than in patients without this complication (49·9±21·0 ng ml−1).Thus, BTG evaluation may have some value in valvular heart disease but, at present, it should be confined to systematic research including prospective studies. [ABSTRACT FROM PUBLISHER]