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Ann Thorac Surg 1989;48:280-283
© 1989 The Society of Thoracic Surgeons

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Articles

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

Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts USA

Accepted for publication April 7, 1989.

^_* Address reprint requests to Dr DiSesa, Brigham and Women's Hospital, 75 Francis St, Boston, MA 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% ([equation]), 7% alter 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; front 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.

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