THE ST-JUDE MEDICAL VALVE - EXPERIENCE WITH 1000 CASES

We analyzed the long-term results of valve replacement with the St, Jude Medical bileaflet valve (St, Jude Medical, Inc., St, Paul, Minn.) in our first 1000 implantations between 1978 and 1992, A total of 399 patients had mitral valve replacement, 471 aortic valve, and 130 double (mitral and aortic) valve replacement. The average patient age was 64 +/- 15 years and the majority of patients (52%) had concomitant coronary disease, With 4328 patient-years of follow-up, 83% of the mitral group, 76% of the aortic group, and 77% of the double valve group were free of thromboembolism at 10 years after operation, and 87% of the mitral group, 82% of the aortic group, and 85% of the double, valve group were free of valve-related hemorrhage, At 10 years, 91% of the mitral group, 84% of the aortic group, and 84% of the double valve group were free of valve-related death, However, overall survival at 10 Sears was only 42% +/- 4% for the mitral group, 43% +/- 4% for the aortic group, and 43% +/- 6% for the double valve group, For all three groups, age was a highly significant factor stratifying survival (p < 0.001), as was the presence of coronary disease (all p < 0.001). The excellent freedom from valve-related death at 10 years of 84% to 91% is in striking contrast to the or overall survivals of 42% to 43% at 10 years, This difference suggests that the primary factors Limiting long-term survival after valve replacement with the St, Jude Medical valve are not valve-related factors, but other patient factors such as age and concomitant coronary disease,