Aortic and Mitral Valve Replacement with the St. Jude Medical® Prosthesis: A Nine-Year Update Report

Abstract

Records of 614 patients (393 AVR, 221 AVR + CAB—Group A) and 421 patients (291 MVR, 130 MVR + CAB—Group B) were reviewed 9 years after the first ST. JUDE MEDICAL® valve was implanted in 1911.* Mean age was 63 years in Group A (410 males and 204 females) and 59 years of age in Group B (113 males and 248 females). The operative mortality was 6.5% (3% AVR, 4.5% AVR + CAB, 8.5% MVR, 16% MVR + CAB). Follow-up was completed in 91.1% of the patients (1450 patient-years in AVR, 186 in AVR + CAB, 1105 in MVR, and 403 in MVR + CAB). Significant improvement in New York Heart Association (NYHA) Functional Classification was seen in Group A but not in Group B, particularly in the MVR + CAB. Actuarial estimates (including operative deaths) showed the same survival of 14.1 ± 6.4% in AVR and AVR + CAB, but only 51.4 ± 8.8% in MVR and 52.3 ± 14.4% in MVR + CAB. AVR and AVR + CAB patients are doing well, however, the ratio of anticoagulant-related hemorrhage to thromboembolism is high in the isolated AVR group (3:1). Therefore, reduction of the COUMADIN® dose is suggested. MVR + CAB patients are not doing well; the LVR group is not quite improved after surgery and incidence of all complications (including deaths) remains high, in spite of the benefits from better hemodynamics of the ST. JUDE MEDICAL prosthesis.