Mid-term results of valve replacement with the ATS valve: A seven-year follow up

Background and aim of the study: The ATS open pivot bileaflet valve has been the prosthesis of choice at the authors' hospital since 1997. Herein is presented a retrospective analysis of the mid-term results of valve replacement with the ATS valve prosthesis. Methods: Between 1997 and 2005, a total of 280 patients (mean age 58.3 years) underwent valve replacement with the ATS valve; these included 133 aortic valve replacements (AVR), 115 mitral valve replacements (MVR), and 32 double (aortic plus mitral) valve replacements (DVR). Preoperatively, 162 patients (57.9%) were in NYHA functional class 11, 97 (34.6%) in class III, 19 (6.8%) in class IV, and two (0.7%) in class V. Atrial fibrillation was detected in 105 patients (37.5%), and significant coronary artery disease was found concomitantly in 13 (4.6%). Postoperative anticoagulant therapy consisting of warfarin and an antiplatelet drug was usually instituted on the first postoperative day, and the International Normalized Ratio maintained between 1.6 and 2.5. Results: Overall hospital mortality was 3.6% (n = 10). Hospital survivors were followed for a mean period of 4.2 years (maximum 10 years); the total follow up was 1,127.9 patient-years (pt-yr). Follow up was complete for 267 patients (98.9%). Actuarial survival at seven years was 87.1% for AVR, 79.8% for MVR, and 90.1% for DVR. The probability of freedom from valve-related death at seven years was 96.7% for AVR, 94.4% for MVR, and 100% for DVR. The linearized rates for postoperative complications were thromboembolism 1.2%/pt-yr, major bleeding 0.7%/pt-yr, prosthetic valve endocarditis 0.2%/pt-yr, non-structural dysfunction 0.7%/pt-yr, and reoperation 0.5%/pt-yr. Structural valve failure was not encountered. Conclusion: This clinical experience with the ATS open pivot heart valve demonstrated low rates of adverse events and valve-related complications.