Chronic haemolysis after Lillehei-Kaster valve replacement. Comparison with the findings after Bjork-shiley and Starr-Edwards mitral valve replacement.

Abstract

Nineteen female and sixteen male patients who have had their heart valves replaced with Lillehei-Kaster valves were investigated for haemolysis four to 18 months after operation. Investigation included serum lactic dehydrogenase, serum haptoglobins, and urine haemosiderin. Red cells survival, using autologous red cells labelled with 51Cr, was measured in 12 patients. No patient showed manifest anaemia. The serum lactic dehydrogenase levels were raised in 66% of the mitral valve patients, 81% of the aortic valve patients, and in all the double valve patients. The serum haptoglobins were decreased in 66% of mitral patients, 68% of aortic valve patients, and in 75% of the double valve patients. All the 12 patients studied had lower than normal red cell survivals. No correlation was found between the incidence of haemolysis and the size of the valve. In isolated mitral valve replacement 66% showed compensated haemolysis compared with 42% in Björk-Shiley valves (p less than 0.05), 85% in Starr-Edwards valves (composite seat) (p less than 0.01), and none in frame-mounted irradiated homografts (previous study) (p less than 0.001).