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The Annals of Thoracic Surgery, Vol 57, 697-702, Copyright © 1994 by The Society of Thoracic Surgeons
K Nakano, H Koyanagi, A Hashimoto, M Kitamura, M Endo, M Nagashima and H Tokunaga
Since July 1978, 1,284 patients have received the St. Jude Medical
prosthesis (425 aortic, 636 mitral, and 223 double aortic-mitral), and the
results in these patients were reviewed according to guidelines of the
Society of Thoracic Surgeons. Follow-up was complete in 98%. Of 80 late
deaths, 29% were valve related. The actuarial survival rate, including
operative deaths, at 12 years was 81.7% and 87.1%, respectively, for aortic
and mitral valve replacement, and it was 82.6% at 11 years after double
valve replacement. All patients were anticoagulated with warfarin to
maintain the thrombotest value between 10% and 25%, which is equivalent to
between 2.8 and 1.6 times the control according to the international
normalized ratio of the prothrombin time. The linearized rate of
complication for aortic, mitral, and double valve replacement, respectively
(expressed as the percent per patient-year), was as follows: structural
deterioration, 0; non-structural dysfunction, 0.16, 0.30, and 0.20; valve
thrombosis, 0.05, 0.09, and 0; thromboembolism, 1.35, 1.63, and 0.79;
anticoagulant- related hemorrhage, 0.10, 0.18, and 0.10; and prosthetic
valve endocarditis, 0.21, 0.06, and 0.20. Reoperation was performed in 16
patients. The freedom from reoperation rate at 12 years was 99.5% and 98.0%
for aortic and mitral valve replacement, respectively, and it was 99.1% at
11 years for double valve replacement. Thus, during the 12- year follow-up
in patient who received the St. Jude Medical prosthesis, the valve
performed satisfactorily and with an acceptable risk of late complication
even though patients were anticoagulated using a lower dose of warfarin.
ARTICLES
Twelve years' experience with the St. Jude Medical valve prosthesis
Department of Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
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