A Study on Throboembolic Complication of the Mitral Valve with Starr-Edwards Ball Valve Prostheses with Reference to a Combined Anticoagulation Utilizing Warfarin and Bucolome

Abstract

Since September 1965 mitral valve replacement has been performed in 145 patients at the University Hospital and affiliated hospital. Hospital and late deaths were noted in respectively 10 patients.
One hundred and nine survivors out of the remaining 125 patients were replaced with various Starr-Edwards ball valve proshteses and have elapsed more than one year after surgery.
In this report, these 109 patients were divided into 3 parts depending on the sort of the replaced ball valves and of anticoagulation immediately after operation.
The first part was consisted of 40 patients with the noncloth-covered ball valve and anticoagulated using Warfarin. Follow-up period ranged from 6 to 11 years and during the time, transiet ischemic cerebral attack (Type I) and cerebral embolism (Type II) were experienced in 15 and 8 patients respectively indicating the rates of 37.5 and 20per cent.
The second part included 40 patients who were implanted by the cloth-covered ball valve, and Warfarin was given to them as an anticoagulation after surgery. Episodes of Type I and II were noted in 5 and 4 patients rating 12.5 and 10.3per cent respectively. Peripheral arterial embolism was also recognized in another 2 patients. Follow-up period in this part ranged from 28 to 72 months.
The third part contained 29 patients with the cloth-covered ball valve and a combined anticoagulation of Warfarin and Bucolome which was supplemented in case of being unsatisfied with Warfarin alone. During the time of 12 to 27 months, episode of Type I was noted in 2 patients (6.9%) and that of Type II in 1 patient (3.4%).
The results showed that implantation of the cloth-covered ball valve instead of the noncloth-covered one decreased the incidence of thrombo-embolic complication in the follow-up period when the incidence was expressed as per patient montlhs, and also supplement of Bucolome to Warfagrin to obtain more long-term stabilization of anticoagulation was expected to be promising from the data disclosed between the second and third part with the same sort of the cloth-covered ball valve. Effect of Bucolome on Warfarin as an anticoagulation is attributed by 1) preventing the combination of Warfarin and albumin and 2) displacing previously combined Warfar in to albumin into the blood as free Warfarin.