Valve replacement with the ATS open pivot bileaflet prosthesis

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Abstract
OBJECTIVE: We sought to evaluate the ATS open pivot bileaflet valve withrespect to haemodynamics and thromboembolism. METHODS: We prospectivelystudied 200 consecutive patients aged 13-80 years. One hundred and nineteenaortic, 103 mitral and 11 tricuspid valves were replaced in 172 single, 23double and 5 triple valve procedures. Thirty- eight were re-operations and51 underwent coronary bypass. Transvalvular gradients were determined bytransoesophageal and transthoracic echocardiography. Patients were followedfor 12 months to 3 years. RESULTS: There were four hospital (2%) and threelate deaths, each non-valve related. Two patients were reoperated forpartial valve dehiscence. One aortic reoperation patient suffered apotential transient thromboembolic event. One tricuspid prosthesisthrombosed after anticoagulation was discontinued but thrombolysis resolvedthis problem. There were no other thromboembolic events. Valve gradientswere equivalent or better than those for other bileaflet valves.CONCLUSIONS: The ATS valve has excellent haemodynamic characteristics and avery low thromboembolic rate, probably related to the convex self- washinghinge mechanism. Consequently, we have reduced anticoagulant levels to INR(international normalised ratio) 1.5 to 2.0 for aortic valve patients insinus rhythm. Early experience suggests that the ATS valve functions wellin the tricuspid position.

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