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Starr–Edwards caged‐ball aortic valve: preserved function 40 years after implantation

A 77-year-old male was admitted with exertional dyspnea (New York Heart Association [NYHA] class III) following an aortic valve replacement with a #27 Starr–Edwards prosthesis (model no. 2400; Edwards Lifesciences, Inc., Irvine, CA, USA) in 1976 at age 37. He had no bleeding or thromboembolic events and the valve appeared to be functioning well on fluoroscopy (Figure 1). Transthoracic echocardiography showed a well-seated prosthesis with trivial central aortic insufficiency (AI), no paravalvular leaks, and an ejection fraction of 65%. However, the peak velocity was 3.3 m/sec, the peak gradient was 56mmHg, and the mean gradient was 28mmHg, resulting in an effective orifice area index of 0.74 cm/m consistent with prosthesis-patient mismatch. The patient underwent an uncomplicated reoperative aortic valve replacement with a #21 Carpentier–Edwards Perimount Magna Ease bioprosthesis (Edwards Lifesciences, Inc.). The explanted Starr–Edwards valve showed no thrombus formation or structural abnormalities (Figure 2). At two months follow-up, the patient was in NYHA Class I and a transthoracic echocardiogram showed no AI, a peak jet velocity of 2.4m/sec, a mean gradient of 12mmHg, and an effective orifice area index of 1.05 cm/m.