Heart valve replacement with the Björk-Shiley monostrut valve in patients over 60 years of age.

Over a period of five years (1983-88) 210 Björk-Shiley monostrut mechanical tilting disc prostheses were implanted in 176 patients over the age of 60. There were 61 aortic valve replacements, 86 mitral valve replacements and 29 multiple replacements. Patients were aged between 61 and 78 years (mean 65.5 years), 89% were in NYHA grades III and IV preoperatively and 34.6% had had previous cardiac surgery. Concomitant coronary surgery was performed in 15.9%. Early mortality was 9.1%. Follow-up is 100% complete. There were eight late deaths (3.1 per 100 patient years) of which three were valve-related (prosthetic endocarditis 2, periprosthetic leak 1). Actuarial survival at five years is 98% for aortic valve replacement and 93% for mitral valve replacement. There were no major embolic events and four possible minor embolic events. Overall freedom from anticoagulant complications was 88.9% at five years. No deaths occurred because of anticoagulant-related haemorrhage. There were no episodes of valve failure (thrombotic obstruction or mechanical disruption). Six patients were reoperated for complications: two for periprosthetic leak and three for prosthetic endocarditis. These results compare favourably with those of other valve substitutes and justify the continuing use of the Björk-Shiley monostrut tilting disc prosthesis in the elderly.