St. Jude Medical valve prosthesis: an analysis of long-term outcome and prognostic factors

Détails

ID Serval
serval:BIB_4D4B2991830F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
St. Jude Medical valve prosthesis: an analysis of long-term outcome and prognostic factors
Périodique
Journal of Thoracic and Cardiovascular Surgery
Auteur⸱e⸱s
Debetaz  L. F., Ruchat  P., Hurni  M., Fischer  A., Stumpe  F., Sadeghi  H., van Melle  G., Goy  J. J.
ISSN
0022-5223 (Print)
Statut éditorial
Publié
Date de publication
01/1997
Volume
113
Numéro
1
Pages
134-48
Notes
Journal Article --- Old month value: Jan
Résumé
Between 1979 and 1984, 321 patients received 354 St. Jude Medical prostheses (194 aortic, 94 mitral, 1 tricuspid, and 32 multiple valve replacements). Follow-up was 96% complete (2967 patient-years; mean 9.5 years per patient). Actuarial event-free rates at 10 years and linearized rates (in parentheses) of late complications were as follows: embolism, 85.0% +/- 2.3% (2.3% per patient-year); anticoagulant-related hemorrhage, 74.8% +/- 2.7% (3.3% per patient-year); cerebrovascular accident, 81.8% +/- 2.5% (2.6% per patient-year); prosthesis thrombosis, 98.5% +/- 0.7% (0.1% per patient-year); endocarditis, 97.2% +/- 1.1% (0.4% per patient-year); prosthesis dysfunction, 97.1% +/- 1.0% (0.4% per patient-year); hemolytic anemia, 98.5% +/- 0.7% (0.1% per patient-year); reoperation, 97.4% +/- 1.0% (0.4% per patient-year); overall mortality, 63.3% +/- 2.7% (4.2% per patient-year); and valve-related death (including sudden death), 84.7% +/- 2.2% (1.4% per patient-year). Independent preoperative risk factors were as follows: (1) for embolism, cardiac failure as indication for operation and history of prior systemic embolism; (2) for cerebrovascular accidents, the same two factors and age; (3) for endocarditis, diabetes, chronic alcoholism, and aortic valve replacement; (4) for overall mortality, age, ejection fraction (or cardiac index or cardiothoracic index), chronic alcoholism, and history of systemic embolism; and (5) for valve-related death, chronic alcoholism, degenerative cause of valve disease, and prosthetic diameter 23 mm or smaller. Ninety percent of survivors were in New York Heart Association functional class I or II at the end of follow-up. In conclusion, this study confirms the excellent durability of the St. Jude Medical valve and the remarkable functional benefit for the majority of the patients. However, prosthesis-related complications are still common, particularly for small-diameter prostheses. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.
Mots-clé
Aged Anticoagulants/adverse effects Cerebrovascular Disorders/etiology Embolism/etiology Female Gastrointestinal Hemorrhage/etiology *Heart Valve Prosthesis Humans Male Middle Aged Prognosis Prosthesis Failure Thrombosis/etiology
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/01/2008 10:39
Dernière modification de la notice
20/08/2019 15:02
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