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J Thorac Cardiovasc Surg 1994;108:1010-1020
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

The St. Jude Medical valveExperience with 1000 cases

Steven Khan, MD, Aurelio Chaux, MD, Jack Matloff, MD, Carlos Blanche, MD, Michele DeRobertis, RN, Robert Kass, MD, Tsung Po Tsai, MD, Alfredo Trento, MD, Sharon Nessim, DrPh, Richard Gray, MD, Lawrence Czer, MD


Los Angeles, Calif.

From the Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.

Address for reprints: Steven S. Khan, MD, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 6215, Los Angeles, CA 90048.

Abstract

We analyzed the long-term results of valve replacement with the St. Jude Medical bileaflet valve (St. Jude Medical, Inc., St. Paul, Minn.) in our first 1000 implantations between 1978 and 1992. A total of 399 patients had mitral valve replacement, 471 aortic valve, and 130 double (mitral and aortic) valve replacement. The average patient age was 64 ± 15 years and the majority of patients (52%) had concomitant coronary disease. With 4328 patient-years of follow-up, 83% of the mitral group, 76% of the aortic group, and 77% of the double valve group were free of thromboembolism at 10 years after operation, and 87% of the mitral group, 82% of the aortic group, and 85% of the double valve group were free of valve-related hemorrhage. At 10 years, 91% of the mitral group, 84% of the aortic group, and 84% of the double valve group were free of valve-related death. However, overall survival at 10 years was only 42% ± 4% for the mitral group, 43% ± 4% for the aortic group, and 43% ± 6% for the double valve group. For all three groups, age was a highly significant factor stratifying survival (p < 0.001), as was the presence of coronary disease (all p < 0.001). The excellent freedom from valve-related death at 10 years of 84% to 91% is in striking contrast to the overall survivals of 42% to 43% at 10 years. This difference suggests that the primary factors limiting long-term survival after valve replacement with the St. Jude Medical valve are not valve-related factors, but other patient factors such as age and concomitant coronary disease. (J THORACCARDIOVASCSURG1994;108:1010-20)




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