LONG-TERM FOLLOW-UP OF ST.-JUDE MEDICAL PROSTHESIS IN A YOUNG RHEUMATIC POPULATION USING LOW-LEVEL WARFARIN ANTICOAGULATION - AN ANALYSIS OF THE TEMPORAL DISTRIBUTION OF CAUSES OF DEATH

This study assesses the long-term (mean 52 +/- 24 months) performance of the Sr, Jude Medical (SJM) valve in 200 young (mean age 31 +/- 13 y ears) rheumatic patients on low-level warfarin anticoagulation combine d with dipyridamole, Follow-up was 95% complete and comprised 867 pati ent-years, There were 33 deaths (3.8%/patient-year), Death was valve r elated in 12 cases and due to left ventricular dysfunction in 10, Deat h due to left ventricular;dysfunction occurred earlier after surgery t han death due to other causes (10 +/- 7 vs 29 +/- 18 months, p <0.005) ; these patients had larger preoperative left ventricular dimensions t han the rest of the group (end-systolic diameter 51 +/- 13 vs 37 +/- 1 6 mm, end-diastolic diameter 66 +/- 13 vs 50 +/- 19 mm, p = 0.006), Ac tuarial probability of survival was 81% at 86 months and probability o f event-free survival was 71%, The median international normalized rat io was 1.88 +/- 0.54, Thromboembolism (13 events) occurred at a linear ized rate of 1.5%/patient-year. There were 11 major bleeding episodes (1.3%/patient-year), 4 cases of prosthetic valve endocarditis (0.8%/pa tient-year), and 12 paraprosthetic leaks (1.4%/patient-year). No valve obstructions or reoperations occurred, Thus, the SJM valve performs w ell on low-level anticoagulation combined with dipyridamole, Left vent ricular dysfunction was a common cause of death in the early postopera tive period, (C) 1998 by Excerpta Medica, Inc.