Ten-year follow-up study of patients who had double valve replacement with the St. Jude Medical prosthesis

Arom, Kit V.; Nicoloff, Demétre M.; Kersten, Thomas E.; Northrup, William F.; Lindsay, William G.; Emery, Robert W.

doi:10.1016/s0022-5223(19)34286-2

Cited by 45 publications

(18 citation statements)

References 14 publications

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“…Similar results in comparable patient cohorts have been reported. [2][3][4]10,11 Nevertheless, the early operative mortality rate is higher and the late survival rate is lower than those after isolated aortic or mitral valve replacement. 1,9,12 Heart failure and sudden, unexpected death are the major late causes of death.…”

Section: Surgical Resultsmentioning

confidence: 99%

“…1,9,12 Heart failure and sudden, unexpected death are the major late causes of death. 3,4,10 Heart failure can occur slowly and insidiously, many years after valve replacement, and heart transplantation might become necessary when myocardial failure is refractory to medical therapy. Thus, current late postoperative survival rates do not exactly correspond to "survival of the heart."…”

Section: Surgical Resultsmentioning

confidence: 99%

“…9 The decreased operative mortality rates and improved late survival rates during the past decade require reassessment of indication for surgery in patients with combined valvular disease. 3,4,10 This study summarizes the experience with combined aortic and mitral surgery during the late 1970s and 1980s, with an emphasis on preoperative clinical and hemodynamic data and the choice of surgical procedures as predictors of long-term survival.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of the Long-Term Outcome After Combined Aortic and Mitral Valve Surgery

Turina

Stark²,

Seifert³

et al. 1999

Circulation

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Background-The influence of preoperative clinical, hemodynamic, and surgical procedures on long-term prognosis after combined aortic and mitral valve surgery is not well known. Methods and Results-One hundred seventy patients (mean age, 50.5 years; 102 men and 68 women) who underwent surgery for chronic combined aortic and mitral valvular disease between 1975 and 1989 were followed up for an average of 10.6 years. Additional repair of tricuspid valve was performed in 29 patients (17%), and aortocoronary bypass graft surgery was performed in 7 patients (4.1%). The perioperative mortality rate was 4%, and 10-and 20-year survival rates were 61% and 33%. Only 12 of 94 deaths (11%) were non-cardiac related. At 10 and 20 years, 57% and 21% of patients were free of reoperation, respectively. The main predictors of late survival in univariate analysis were age at surgery (Pϭ0.0002), preoperative left ventricular ejection fraction (Pϭ0.002), cardiac index (Pϭ0.007), tricuspid surgery (Pϭ0.03), pulmonary vascular resistance (Pϭ0.03), NYHA class (Pϭ0.04), and additional aortocoronary bypass graft surgery (Pϭ0.04). Duration of symptoms, gender, cause of valvular disease, and type of prosthesis were not predictive of postoperative outcome. In multivariate stepwise Cox analysis, ejection fraction (Pϭ0.0008), age at surgery (Pϭ0.0011), and tricuspid surgery (Pϭ0.007) were independent predictors of late survival. Conclusions-In combined aortic and mitral valve disease, preoperative myocardial function is the main predictor of long-term survival. Low operative mortality rates and good late outcome make valve replacement mandatory before deterioration of myocardial function occurs. Additional tricuspid valve disease requiring surgery significantly decreases the late survival rate. (Circulation. 1999;100[suppl II]:II-48-II-53.) Key Words: surgery Ⅲ valves Ⅲ survival Ⅲ prognosis Ⅲ transplantation S urgery for combined aortic and mitral valve disease was introduced in the early 1960s; until the mid-1970s, it was associated with a high operative mortality rate and unsatisfactory late results. 1-3 Despite well documented improvement in surgical techniques with a marked decrease in operative mortality rates and a considerable increase in late postoperative survival rates in the 1980s and 1990s, some reluctance remained to refer a patient with combined aortic and mitral disease to surgery. 4,5 A paucity of experience due to the limited number of patients, a lack of good prospective clinical and hemodynamic studies in patients who have not undergone surgery, great differences in clinical presentation and hemodynamics between regurgitant and stenotic lesions, and changes in causes of valvular disease in developed countries aggravate the decision-making process for surgery in patients with combined aortic and mitral disease. 1,6,7 This was the main reason for reassessment of preoperative clinical, hemodynamic, and surgical predictors for long-term survival after combined aortic and mitral valve surgery in patients operated on at our institu...

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Section: Surgical Resultsmentioning

confidence: 99%

Section: Surgical Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of the Long-Term Outcome After Combined Aortic and Mitral Valve Surgery

Turina

Stark²,

Seifert³

et al. 1999

Circulation

View full text Add to dashboard Cite

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“…Risk factors for death were preoperative NYHA functional class III or greater, and preoperative diuretics, both reflecting poor ventricular function as in double valve replacement patients. 11 Surprisingly, an erratic INR, merely a consequence of poor medical follow up, compromises survival. The incidence of thromboembolism and haemorrhage for ATS valves, in our experience, seems to compare favourably to those reported in some other mechanical valve series.…”

Section: Discussionmentioning

confidence: 99%

Lower anticoagulation for mechanical heart valves: Experience with the ATS bileaflet valve

Nooten

Taeymans

Belleghem

et al. 2003

Heart, Lung and Circulation

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“…The causes of reoperation included thrombosed prosthetic valves, pannus formation restricting prosthetic valve function, and paravalvular leaks with or without infective endocarditis. The linearized rate of mechanical valve thrombosis was between 0.04% and 0.39% per patient-year (8,14,(21)(22)(23)(24)(25). Paravalvular leak occurred at a rate of 0.1% to 0.92% per patient-year (8,21,24,26) and endocarditis at the rate of 0.1% to 0.53% per patient-year (7,14,21,23).…”

Section: Discussionmentioning

confidence: 99%

Single‐Center Experience with the Bicarbon Bileaflet Prosthetic Heart Valve in Japan

et al. 2002

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We analyzed midterm results using the Bicarbon valve in a single center. Forty-four patients had aortic valve replacement (AVR), 48 had mitral valve replacement (MVR), and 13 had both aortic and mitral valve replacement (DVR). The mean age of the 105 patients was 61.2 +/- 11.3 years. The mean follow-up was 1.8 +/- 1.1 years with a cumulative follow-up of 188 patient-years. There were 5 early deaths (4.7%: 4 in the AVR group and 1 in the MVR group) and 5 late deaths (2.7% per patient-year: 3 malignancy, 1 cerebral hemorrhage, 1 myocardial infarction). Survival at 3 years was 91 +/- 4% in the AVR group, 92 +/- 5% in the MVR group, and 66 +/- 23% in the DVR group. The linearized incidence of thromboembolic complications, hemorrhagic complications, and paravalvular leaks in all patients was 1.06 +/- 2.34%, 1.60 +/- 2.53%, and 0.53 +/- 2.22% per patient-year, respectively. No other complications were observed. In conclusion, the Bicarbon prosthetic heart valve has shown excellent clinical results associated with a low incidence of valve-related complications.

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Ten-year follow-up study of patients who had double valve replacement with the St. Jude Medical prosthesis

Cited by 45 publications

References 14 publications

Predictors of the Long-Term Outcome After Combined Aortic and Mitral Valve Surgery

Predictors of the Long-Term Outcome After Combined Aortic and Mitral Valve Surgery

Lower anticoagulation for mechanical heart valves: Experience with the ATS bileaflet valve

Single‐Center Experience with the Bicarbon Bileaflet Prosthetic Heart Valve in Japan

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