ST-JUDE MEDICAL CARDIAC VALVES IN SMALL AORTIC ROOTS - FOLLOW-UP TO 16 YEARS

Prosthetic aortic valve replacement in the small aortic root raises co ncerns of its long-term effects. Between 1978 and 1994, 270 patients r eceived only small aortic prostheses (less than or equal to 21 mm). Th ere were 117 men (43.3%) and 153 women (56.7%) with a mean age of 64.3 +/- 11.6 years (range 19 to 87 years). The body surface areas ranged from 1.2 to 2.26 m(2) (mean 1.71 +/- 0.27 m(2)). Ninety-one percent of patients had New York Heart Association class III or TV symptoms and 33% underwent concomitant coronary artery bypass grafting. The operati ve mortality rate was 3.3% (9 deaths) and follow-up (100%) extended fr om 1 to 16 years (mean 6.2 +/- 3.9 years),vith cumulative survival of 1676 patient-years. There were 55 late deaths (3.28% per patient-year) . The linearized rates of morbidity reported as percent per patient-ye ar were as follows: structural failure, 0%; paravalvular leak, 0.12%; prosthetic endocarditis, 0.24%; anticoagulant-related morbidity, 1.24% ; and thromboembolism, 1.10%, In 89% of the survivors New York Heart A ssociation functional performance had improved to class II or I. The a ctuarial survival with 95% confidence intervals at 5, 10, and 16 years was 86.9% (82.5%, 91.3%), 68.6% (60.6%, 76.6%), and 53.6% (36.6%, 70. 6%), respectively, Freedom from late valve-related events (95% confide nce intervals) at 10 and 16 years was as follows: thromboembolism, 91. 2% (86.6%, 95.8%) and 78.3% (62.6%, 94%); anticoagulant-related morbid ity, 89.1% (83.8%, 94.4%) and 81.0% (65.1%, 96.9%); and prosthetic end ocarditis, 98.8% (97.5%, 100%) and 98.8% (97.5%, 100%), respectively, Multivariate analysis revealed age at operation, myocardial infarction , and endocarditis affected the long-term survival. The risk of sudden death irrespective of body surface area and valve size was not statis tically different, Thus the long-term performance of the St, Jude Medi cal valve in small aortic roots is satisfactory.