HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by DiSesa, V. J. Articles by Cohn, L. H. Search for Related Content PubMed PubMed Citation Articles by DiSesa, V. J. Articles by Cohn, L. H.

The Annals of Thoracic Surgery, Vol 48, 280-283, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Hematological complications with the St. Jude valve and reduced-dose Coumadin

VJ DiSesa, JJ Collins Jr and LH Cohn
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.

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.

This article has been cited by other articles:

				T. Gudbjartsson, T. Absi, and S. Aranki Mitral Valve Replacement Card. Surg. Adult, January 1, 2008; 3(2008): 1031 - 1068. [Full Text]

				T. Gudbjartsson, S. Aranki, and L. H. Cohn Mechanical/Bioprosthetic Mitral Valve Replacement Card. Surg. Adult, January 1, 2003; 2(2003): 951 - 986. [Full Text]

				C. Huth, A. Friedl, A. Rost, and for the GELIA Study Investigator Group Intensity of oral anticoagulation after implantation of St. Jude Medical aortic prosthesis: analysis of the GELIA Database (GELIA 4) Eur. Heart J. Suppl., December 1, 2001; 3(suppl_Q): Q33 - Q38. [Abstract] [PDF]

				P. V Andersen, J. Aagaard, P. V Andersen, and J. Aagaard Low-Dose Warfarin in Patients With Carbomedics Heart Valve Prostheses Asian Cardiovasc Thorac Ann, March 1, 2000; 8(1): 11 - 14. [Abstract] [Full Text] [PDF]

				A. Tasdelen, C. Ikizler, S. Aslamaci, A. Yavari, E. Ekici, and G. Arslan Three-Year Experience With the Ultracor Valve Prosthesis Asian Cardiovasc Thorac Ann, December 1, 1998; 6(4): 265 - 269. [Abstract] [Full Text] [PDF]

				X. M. Mueller, H. T. Tevaearai, F. Stumpe, A. P. Fischer, M. Hurni, P. Ruchat, and L. v. Segesser Long-term results of mitral-aortic valve operations J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1298 - 1302. [Abstract] [Full Text] [PDF]

				T. E. David, V. L. Gott, L. A. Harker, G. E. Miller Jr, D. C. Naftel, A. G. G. Turpie, and C. W. Akins Mechanical Valves Ann. Thorac. Surg., November 1, 1996; 62(5): 1567 - 1570. [Full Text]

				J. Acar, B. Iung, J. P. Boissel, M. M. Samama, P. L. Michel, J. P. Teppe, J. C. Pony, H. Le Breton, D. Thomas, R. Isnard, et al. AREVA: Multicenter Randomized Comparison of Low-Dose Versus Standard-Dose Anticoagulation in Patients With Mechanical Prosthetic Heart Valves Circulation, November 1, 1996; 94(9): 2107 - 2112. [Abstract] [Full Text]

				C. W. Akins Results With Mechanical Cardiac Valvular Prostheses Ann. Thorac. Surg., December 1, 1995; 60(6): 1836 - 1844. [Abstract] [Full Text]

				R. G. Masters, A. L. Pipe, V. M. Walley, and W. J. Keon Comparative results with the St. Jude Medical and Medtronic Hall mechanical valves J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 663 - 671. [Abstract] [Full Text]

				S.C. Cannegieter, F.R. Rosendaal, A.R. Wintzen, F.J.M. van der Meer, J.P. Vandenbroucke, and E. Briet Optimal Oral Anticoagulant Therapy in Patients with Mechanical Heart Valves N. Engl. J. Med., July 6, 1995; 333(1): 11 - 17. [Abstract] [Full Text] [PDF]

				M. H. Eckman, H. J. Levine, and S. G. Pauker Effect of Laboratory Variation in the Prothrombin-Time Ratio on the Results of Oral Anticoagulant Therapy N. Engl. J. Med., September 2, 1993; 329(10): 696 - 702. [Abstract] [Full Text]