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The Annals of Thoracic Surgery, Vol 58, 1721-1728, Copyright © 1994 by The Society of Thoracic Surgeons
O Jegaden, A Eker, F Delahaye, P Montagna, J Ossette, G Durand de Gevigney and PH Mikaeloff
From January 1979 to December 1990, 397 consecutive patients (mean age, 55
+/- 11 years) underwent mitral valve replacement with the St. Jude Medical
valve. Associated procedures performed were 174 multiple valve
replacements, 24 coronary artery bypass graftings, 25 tricuspid repairs,
and 13 left ventricular myectomies. The continuous intravenous
administration of heparin was started on the first postoperative day and
maintained until effective oral anticoagulation, started on the seventh
day, was achieved (INR, 3 to 4.5). Follow-up consisted of 2,402
patient-years (pt-y) (mean, 6.1 +/- 0.2 years) and was 97% complete. The
early (30-day) mortality was 3.5%; the 5-year and 10-year actuarial
survivals were 86% +/- 4% and 73% +/- 6%, respectively. Survival was less
in patients who had been in an advanced preoperative functional class (p =
0.02) and in those who underwent multiple valve replacements (p = 0.05).
The 5-year and 10-year survivals in patients who underwent isolated mitral
valve replacement and who were in preoperative New York Heart Association
functional class II and III, were 90% +/- 5% and 82% +/- 7%, respectively.
The early and late mortality and the incidence of deaths resulting from
heart failure and sudden deaths were higher in patients who had undergone
multiple valve replacements (p = 0.05). In terms of all deaths, 47% (36/77)
were valve related (including 12 sudden deaths, 0.50%/pt-y). Thromboembolic
complications occurred in 44 patients, and these were broken down as
follows: embolism, 1.46%/pt-y, and valve thrombosis, 0.37%/pt-y.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Thromboembolic risk and late survival after mitral valve replacement with the St. Jude Medical valve
Department of Cardiovascular Surgery, Hopital Cardiologique, Lyon, France.
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