title: The St. Jude Medical valve. Experience with 1,000 cases.
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.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.forename: A
authors.initials: A
authors.lastname: Chaux
authors.forename: J
authors.initials: J
authors.lastname: Matloff
authors.forename: C
authors.initials: C
authors.lastname: Blanche
authors.forename: M
authors.initials: M
authors.lastname: DeRobertis
authors.forename: R
authors.initials: R
authors.lastname: Kass
authors.forename: T P
authors.initials: TP
authors.lastname: Tsai
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.forename: S
authors.initials: S
authors.lastname: Nessim
authors.forename: R
authors.initials: R
authors.lastname: Gray
mesh_terms: D000368:Aged; D001021:Aortic Valve; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D014859:Warfarin