The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 444-447, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A decade of experience with the Model 103 and 104 Beall valve prostheses
AW Joob, IL Kron, GB Craddock, RL Mentzer Jr, SP Nolan and IK Crosby
Mitral or tricuspid valve replacement with the Beall Model 103 or 104
prosthesis has been associated with a high incidence of late prosthetic
malfunction which has necessitated reoperation. Between 1972 and 1975, 57
patients underwent single valve replacement (55 mitral and two tricuspid)
with Beall Model 103 or 104 valvular prostheses and survived at least 2
years. The mean follow-up time was 73.7 months (range 24 to 119 months). Of
these patients, 22 required explantation of the prosthesis; there was an
operative mortality of 27%. Major prosthetic malfunction occurred in four
patients: Two occluders were embolized and two occluders were fixed in the
open position. All four patients required urgent operation, and two of them
died. The development of symptoms of congestive heart failure, systolic
murmur, or hemolysis were the reasons for cardiac catheterizations and
possible reoperation. Nineteen patients had cardiac catheterization.
Fifteen of these subsequently underwent reoperation, with a mortality of
26%. Three patients were considered inoperable. Cardiac catheterization
data revealed significant prosthetic regurgitation in all patients:
pulmonary capillary pressure 29.9 mm Hg +/- 6.7 (standard deviation); V
wave 31.5 mm Hg +/- 12.0; left ventricular end-diastolic pressure 18.0 mm
Hg +/- 7.8. Comparison of hemolysis indicators in this group to those of
asymptomatic patients revealed that the former had a significant elevation
in lactic dehydrogenase (p = 0.038) and a lowered hematocrit value (p =
0.017). Waiting for severe symptomatic deterioration to justify reoperation
risks the development of left ventricular dysfunction and possible
emergency reoperation with a high operative mortality.
