Hematological complications with the St. Jude valve and reduced-dose Coumadin.
We examined hematological complications in 415 patients having valve replacement with the St. Jude mechanical prosthesis (212, aortic valve replacement [AVR]; 159, mitral valve replacement [MVR]; and 44, AVR + MVR). There were 164 men and 251 women with a mean age of 59 years (range, 20 to 88 years). Preoperatively 386 patients were in New York Heart Association functional classes III and IV. There were 154 associated procedures (37%), the most common being myocardial revascularization. Overall hospital mortality was 7.5% (31/415), 7% after AVR, 8% after MVR, and 7% after AVR + MVR. All operative survivors were anticoagulated with Coumadin (crystalline warfarin sodium) to maintain the prothrombin time at 1.5 times control. During a mean follow-up of 21 months (range, 6 to 60 months), there were 29 late deaths (7.6%) and 5 patients (1.3%) lost to follow-up. No patient experienced structural valve degeneration. At 48 months, actuarial freedom from thromboembolism was 87% +/- 3% after AVR and 91% +/- 9% after MVR; from anticoagulation-related hemorrhage, 97% +/- 3% after AVR and 91% +/- 3% after MVR; and from hemolysis, 100% after AVR and 98% +/- 2% after MVR. Freedom from all valve-related morbidity at 4 years was 82% +/- 5% after AVR and 75% +/- 10% after MVR. Actuarial survival at 48 months was 80% +/- 4% after AVR and 65% +/- 7% after MVR.
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
V J
VJ
DiSesa
J J
JJ
Collins
L H
LH
Cohn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006402:Hematologic Diseases / Q000209:etiology*; D006461:Hemolysis; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D013923:Thromboembolism / Q000401:mortality; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D014859:Warfarin