Forty-year durability of a Smeloff-Cutter ball valve prosthesis in the mitral position

A rare case requiring replacement of an intact Smeloff-Cutter ball prosthesis in the mitral position 40 years after implantation is presented. The Smeloff-Cutter ball valve prosthesis was designed to have two open cages. It has two potential advantages: a relatively large, effective orifice area and its self-washing effect that prevents thrombus formation. There have been only a few reports of survivors with ball valve prostheses in place for more than three decades especially in the mitral position. This is a valuable report describing the long-term durability of a Smeloff-Cutter ball valve prosthesis in the mitral position.     

43.3-year durability of a Smeloff-Cutter ball-caged mitral valve

Extended durability of mechanical heart valves has been documented for many years. We describe a case of a ball-caged mechanical valve implanted 43.3 years previous to developing valve dysfunction. The patient presented with both prosthetic valve stenosis and insufficiency. This Smeloff-Cutter valve (Cutter Laboratories, Berkeley, CA) in the mitral position was dysfunctional due to lipid absorption, which resulted in ball variance and concomitant pannus growth prevented optimal seating of the ball in its cage. This is the longest length of time in which a Smeloff-Cutter mechanical valve has been originally implanted.     

A case report of ball variance of Smeloff-Cutter prosthetic valve

A 37-year-old woman had undergone aortic valve replacement with Smeloff-Cutter prosthetic valve in 1967. She visited our hospital because of dyspnea and chest pain about 22 years after the operation. Severe aortic regurgitant murmur was audible and a chest X-ray demonstrated lung edema. A diagnosis was made of acute left heart failure due to prosthetic valve dysfunction, and emergency operation was performed. The Silastic ball was severely deformed and shrunken. Therefore, the ball was easily put off outside the cage. A St. Jude medical prosthetic valve was implanted. The postoperative course was uneventful.     

Comparative analysis of tilting disc and ball valve prosthesis in aortic position

In a retrospective analysis, comparison was made between the Cutter-Smeloff ball valve (n = 63) and the Lillehei-Kaster tilting disc valve (n = 256) in the aortic position. No significant intergroup difference was found as regards rate of thromboembolism (0.6/100 patient years for both valve types), endocarditis (0.2 for Cutter-Smeloff and 0.5 for Lillehei-Kaster/100 patient years) and paraprosthetic leak (0.9 and 0.5, respectively/100 patient years). The actuarial curve of cumulative survival was similar for both valves until 6 years postoperatively. Thereafter the outcome was less favourable for the patients with Cutter-Smeloff valve (actuarial survival 79 +/- 5% than for those with Lillehei-Kaster valve (91.2 +/- 2%). The reason for this, statistically significant, difference may be associated with the difference in valve profiles.     

Outcome of aortic valve repair in children with congenital aortic valve insufficiency

OBJECTIVE: Surgical aortic valvotomy has a long history of providing excellent palliation for aortic stenosis in infancy and childhood. The fate of aortic valve repairs for dominant aortic regurgitation in this same age group is considerably less clear. METHODS: From 1990 to 2000, a total of 21 patients underwent aortic valve repair for aortic regurgitation at our institution. Seventeen patients were younger than 17 years at the time of repair (3-17 years, mean 8.1 +/- 3.7 years). Of these 17 children, 6 (35%) had bicuspid valves and 11 (65%) had tricuspid valves. Type of repair varied with valve type, but repair generally consisted of commissure resuspension, partial commissure closure, triangular resection of redundant leaflets, or some combination. RESULTS: There were no deaths. Follow-up ranged from 1 to 11 years (mean 5.3 +/- 2.4 years). At present 3 of 17 (17.6%) have mild aortic regurgitation according to echocardiography and 6 (35.2%) have moderate aortic regurgitation. In 8 of 17 cases (47.1%) the repair clearly failed, requiring reoperation from 0.5 to 73 months after the original operation (mean 18.9 months). Reoperation consisted of 6 Ross procedures and 2 mechanical aortic valve replacements. There were no deaths at the secondary operation. CONCLUSION: Aortic valve repair in children with a dominant feature of aortic insufficiency tended to fail progressively and at a high rate. Leaflet thickening was associated with higher risk of repair failure in this series. The threshold for aortic valve replacement should remain low.     

Aortic valve replacement with Smeloff-Cutter prosthesis: 1 to 8 year follow-up

Two hundred patients had an aortic valve replacement with the Smeloff-Cutter prosthesis between 1972 and 1980. One hundred and seventy six patients had aortic valve replacement alone (mortality 2.8%) and 24 patients had additional procedures. The overall mortality was 6.5%. One hundred and eighty seven patients have been followed up for from 4 months to 8 years (mean 33 months). The 14 patients who died later are analysed; half of these deaths were prosthesis related. There has been no instance of structural failure, ball variance or massive thrombosis in this series. All but 4 of the survivors showed functional improvement. We consider the Smeloff-Cutter valve a good choice for aortic valve replacement.