Aortic valve replacement in patients 50 years old or younger with the St. Jude Medical valve: 14-year experience.
OBJECTIVE
Ninety-one of 351 patients who received an aortic valve replacement (AVR) with the St. Jude Medical (SJM) valve at the Royal Melbourne Hospital between 1978 and 1990 were 50-year-old or younger. The results of these patients were retrospectively analyzed so that comparison may be made with the long term results of homograft AVR.


METHODS
There were 75 males and 16 females. Mean age was 39 years (range 15-50 years). Valve pathologies were, congenital (32), degenerative (30), rheumatic (20), infective endocarditis (7). All patients had warfarin post-operatively.


RESULTS
Follow up was complete with a total of 689 patients years, (range 34 months to 14.75 years, mean 7.6 years). There were two operative deaths (2.2%) and three late deaths (0.5 +/- 0.3%/patient-year) and two have undergone subsequent cardiac transplantation. Seventy-eight of 86 survivors (91%) are in NYHA functional Class I. At 10 years, actuarial survival was 94 +/- 2.9%, freedom from embolism was 96.4 +/- 2.4%, and from anticoagulant (AC) hemorrhage 89.4 +/- 6.5%. There were no structural failures; four cases paravalvular leaks were reported. Freedom from non-structural deterioration at 10 years was 95.3 +/- 2.3%. Freedom from reoperation was 95.6 +/- 3.2% at 10 years. Linearized rates (% per patient-year) were for embolism 0.6 +/- 0.5, AC hemorrhage 0.8 +/- 0.2, non-structural dysfunction 0.8 +/- 0.2 for endocarditis 0.4 +/- 0.5, and for reoperation 0.4 +/- 0.4.


CONCLUSIONS
The SJM valve prosthesis has performed well in the aortic position in this younger group of patients up to 10 years.
Tatoulis
J
J
Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Australia.
Chaiyaroj
S
S
Smith
J A
JA
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate