Late follow-up of ball-valve prostheses in the descending thoracic aorta.

Clincal and hemodynamic observations are reported in a group of five patients with free aortic regurgitation treated with insertion of a ball valve prosthesis in the descending aorta. Long-term follow-up ranging from 13 to 23 years illustrates the durability and biocompatibility of the valve and the validity of the concept that a moving prosthesis can function for indefinitely long periods of time. The prolonged survival of these patients at a normal level of activity without congestive failure is strong evidence of the efficacy of the prosthesis even though it did not entirely control all of the aortic insufficiency. All patients showed remarkable improvement of their symptoms from 11 to 21 years after surgery. Four of them have required complete correction of the aortic insufficiency with one postoperative death due to low output syndrome. The valves which have remained in place after insertion of a subcoronary valve are functioning well for 3 to 6 years. There was no evidence of hemolysis, valve malfunction, ball variance, or thrombbosis in any of these patients. The evolution of the technique made it possible to minimize complications which, it should be pointed out, were usually associated with faulty methods of insertion. These patients would appear to represent the longest period of insertion of any valvular prosthesis.