[Midpoint follow-up results of aortic valve replacement with the Ionescu-Shiley pericardial bioprosthesis. Apropos of 109 patients].

Between March 1980 and May 1985, 109 adults with an average age of 59 years underwent aortic valve replacement with a pericardial Ionescu-Shiley xenograft. Twenty six of the prostheses were of small size (N 19 and 21). In 20 patients, the operation was associated with another procedure (15 aorto coronary bypass grafts and 5 conservative mitral valve procedures). Before surgery, 73.4% of patients were in functional Stages III or IV, and 9.2% had permanent or paroxysmal atrial fibrillation. The average follow-up period was 24 months (4 to 59). The operative mortality was 5.5%. The 4 year actuarial survival rate was 86% with 82% good functional results. At the same date, 96.4% of patients had not developed endocarditis, 96% had not been reoperated and 93.8% had no prosthetic valve dysfunction. No cases of primary degeneration were observed but a diastolic murmur without any haemodynamic consequences was detected in 20% of patients at 4 years. Seventy four per cent of subjects were not anticoagulated at 1 year and 85% were without anticoagulants after one year. Only one haemorrhagic complication was noted (0.46% patient/years). There were no cases of occlusive thrombosis; the incidence of thromboembolism was 3.7% patient/years in aortic without mitral valve disease, irrespective of the cardiac rhythm and 2.7% patient/years in patients in sinus rhythm. In this subgroup, 88% had not had any thrombo-embolic complication despite the absence of anticoagulants at 4 years. An Indium III labelled platelet scan was positive in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)