Outcome analysis of 245 CarboMedics and St. Jude valves implanted at the same institution.
BACKGROUND
Thromboembolism and valve-related death are major complications associated with prosthetic valve implants, but it is difficult to evaluate the relative incidence of these complications based on studies in which the implantation of only one valve is reported from any given institution. We therefore report the outcome of patients implanted at our institution during the same time period with either the recently released CarboMedics (CM) or the St. Jude Medical (SJ) valve prostheses.


METHODS
Between October 1994 and January 1996, 245 consecutive patients received either SJ (116 patients) or CM (129 patients) valves at our institution. Follow up of these patients was 99.6% complete, for a total of 318.5 cumulative patient-years (median follow-up, 1.4 years).


RESULTS
The 30-day mortality rates for SJ and CM implants were 3.4% and 3.1%, respectively. Actuarial survival and freedom from valve related mortality rates at 1.5 years for SJ and CM valves were 94%+/-2% versus 86%+/-3% (p = 0.03) and 100% versus 94%+/-2% (p = 0.005), respectively. There was no structural valve failure for either implant, but there were five thrombosed valves in the CM group and none in the SJ group (p = 0.04). All thrombosed valves were mitral (four mitral valve replacement, one aortic and mitral valve replacement). Two of the thrombosed valves were successfully explanted, whereas the three remaining patients died. Freedom from a thromboembolic event in the mitral position at 1.5 years, including thrombosed valves was 97%+/-3% and 83%+/-5% for SJ and CM valves, respectively (p = 0.04).


CONCLUSIONS
The results of this study suggest that further evaluation of thromboembolic outcomes after CM compared with SJ valve implantation is warranted.
Rosengart
T K
TK
Department of Cardiothoracic Surgery, The New York Hospital-Cornell Medical Center, New York 10021, USA.
O'Hara
M
M
Lang
S J
SJ
Ko
W
W
Altorki
N
N
Krieger
K H
KH
Isom
O W
OW
D001021:Aortic Valve; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D011475:Prosthesis Failure; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome