HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Armenti, F. Articles by Edmunds, L. H. Search for Related Content PubMed PubMed Citation Articles by Armenti, F. Articles by Edmunds, L. H., Jr

The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 733-739, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Simultaneous implantation of St. Jude Medical aortic and mitral prostheses

F Armenti, LW Stephenson and LH Edmunds Jr
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104.

Since January 1980, 92 consecutive patients received St. Jude Medical aortic and mitral prostheses simultaneously. Mean age was 57.6 years (standard deviation 12.4); 14 were 70 years or older. Twenty-three had a previous cardiac operation and 22 had additional procedures performed at the time of double valve replacement. Before the operation 62% of the patients were in New York Heart Association functional class III and 29% were in class IV or required emergency operation. There were six (6.5%) deaths within 30 days. None of the hospital deaths were valve related; all occurred in patients who had additional risk concerns. Follow-up is 100% complete and ranges from 2 to 80 months, totaling 242 patient-years (mean 33.8 months). All except four hospital survivors reached class I or II and 40 patients (47%) remain asymptomatic. The actuarial survival rates are 82% at 1 year, 70% at 3 years, and 60% at 5 years. Causes of late death include heart failure (10), sudden, unexplained death (five), reoperation for coronary artery disease (one), noncardiac (four), and valve related (five). The linearized rate of fatal valve-related events is 2.1% pt-yr. A total of 22 valve-related complications (including five fatal) occurred is 18 patients, for a linearized rate or incidence of 9.1%/pt-yr. Eleven thromboembolic episodes (rate 4.6%/pt-yr) occurred in nine patients; three of these (1.2%/pt-yr) were fatal. Thromboembolic and bleeding complications represented 64% of all valve-related complications. Four patients had six episodes of prosthetic valve endocarditis (incidence 2.5%/pt-yr), of which one (incidence 0.4%/pt-yr) was fatal. Paravalvular leak contributed to the fifth valve-related death. At 5 years, 83% of patients were free of thromboembolic complications; 94% were free of anticoagulant-related hemorrhage; and 71% were free of all valve-related complications. There are few comparable data for patients who have had simultaneous replacement of aortic and mitral valves with other mechanical prostheses. The total incidence of valve-related complications for patients with bioprostheses ranges between 3.9%/pt-yr and 10.4%/pt-yr and is similar to the 9.1%/pt-yr observed in the present series. The type of valve-related complication (thromboemboli and bleeding versus valve deterioration) is the principal difference between St. Jude Medical and bioprosthetic valves in patients who require simultaneous replacement of aortic and mitral valves.

This article has been cited by other articles:

				H. V. Schaff and R. M. Suri Multiple Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 1129 - 1158. [Full Text]

				S. Talwar, A. Mathur, S. K. Choudhary, R. Singh, and A. S. Kumar Aortic Valve Replacement With Mitral Valve Repair Compared With Combined Aortic and Mitral Valve Replacement Ann. Thorac. Surg., October 1, 2007; 84(4): 1219 - 1225. [Abstract] [Full Text] [PDF]

				M. Hamamoto, K. Bando, J. Kobayashi, T. Satoh, Y. Sasako, K. Niwaya, O. Tagusari, T. Yagihara, and S. Kitamura Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement Ann. Thorac. Surg., January 1, 2003; 75(1): 28 - 34. [Abstract] [Full Text] [PDF]

				H. V. Schaff and D. H. Marsh Multiple Valve Disease Card. Surg. Adult, January 1, 2003; 2(2003): 1017 - 1045. [Full Text]

				S. John, E. Ravikumar, C. N. John, and V. V. Bashi 25-year experience with 456 combined mitral and aortic valve replacement for rheumatic heart disease Ann. Thorac. Surg., April 1, 2000; 69(4): 1167 - 1172. [Abstract] [Full Text] [PDF]

				J. L. Halperin, S. J. Fry, and S. L. Houser Case 37-1999 -- A 72-Year-Old Woman with a Prosthetic Aortic Valve and Intracranial Hemorrhage N. Engl. J. Med., December 9, 1999; 341(24): 1829 - 1835. [Full Text] [PDF]

				J. Turina, T. Stark, B. Seifert, and M. Turina Predictors of the Long-Term Outcome After Combined Aortic and Mitral Valve Surgery Circulation, November 9, 1999; 100(90002): II-48 - 53. [Abstract] [Full Text] [PDF]

				X. M. Mueller, H. T. Tevaearai, F. Stumpe, A. P. Fischer, M. Hurni, P. Ruchat, and L. v. Segesser Long-term results of mitral-aortic valve operations J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1298 - 1302. [Abstract] [Full Text] [PDF]

				R. P. Cochran, K. S. Kunzelman, A. C. Eddy, B. O. Hofer, and E. D. Verrier Modified conduit preparation creates a pseudosinus in an aortic valve-sparing procedure for aneurysm of the ascending aorta J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1049 - 1058. [Abstract] [Full Text]

				A. C. Fiore, M. T. Swartz, T. G. Sharp, K. A. Kesler, H. B. Barner, K. S. Naunheim, G. L. Grunkemeier, D. A. Moroney, and G. C. Kaiser Double-Valve Replacement With Medtronic-Hall or St. Jude Valve Ann. Thorac. Surg., May 1, 1995; 59(5): 1113 - 1119. [Abstract] [Full Text]

				G. A. Thomas, P. I. Lelkes, S. Isoda, D. Chick, H. Lu, R. L. Hammond, H. Nakajima, H. Nakajima, H. L. Walters III, and L. W. Stephenson Endothelial cell-lined skeletal muscle ventricles in circulation J. Thorac. Cardiovasc. Surg., January 1, 1995; 109(1): 66 - 73. [Abstract] [Full Text]

				M. Ibrahim, H. O'Kane, J. Cleland, D. Gladstone, M. Sarsam, and C. Patterson The St. Jude Medical prosthesisA thirteen-year experience J. Thorac. Cardiovasc. Surg., August 1, 1994; 108(2): 221 - 230. [Abstract] [Full Text]

				J. Fernandez, G. W. Laub, M. S. Adkins, W. A. Anderson, C. Chen, B. M. Bailey, L. M. Nealon, and L. B. McGrath Early and late-phase events after valve replacement with the St. Jude Medical prosthesis in 1200 patients J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 394 - 407. [Abstract] [Full Text]