Aortic valve replacement. A randomized study comparing the Björk-Shiley and Lillehei-Kaster disc valves. Transvalvular regurgitation and occurrence of paravalvular fistulas.

Three hundred patients were selected at random in order to compare the Björk-Shiley (B-S) and the Lillehei-Kaster (L-K) valves in the aortic position. The transvalvular regurgitation was evaluated by peroperative flow recordings in 97 cases. The leakage was found to be 7.6% and 7.5% of forward flow in the B-S and L-K valves, respectively. The regurgitant flow pattern, however, was different in the two groups, as leakage on closure was significantly larger in the L-K valves, and the leakage after closure of the disc was significantly larger in the B-S valves. Follow-up cine-aortography was carried out two years postoperatively in 91 patients. The contrast leakage through the valves was found to be minimal (Grade I) in about 90% in both groups. In one patient with a L-K valve no leakage could be demonstrated. In the remaining patients the leakage was moderate (Grade II). Paravalvular fistulas were demonstrated in three patients from each group. In one patient the paravalvular regurgitation was marked (Grade III), in the others moderate (Grade II). Cine-aortography was also carried out in a further 9 patients, in whom a paravalvular leakage was suspected according to clinical follow-up examinations. In four of these patients a paravalvular regurgitation was demonstrated. The leakage was moderate in two patients and severe (Grade IV) in another two, who were successfully re-operated on.