Isolated mitral valve replacement with St Jude Medical prosthesis - Long-term results: A follow-up of 19 years

Background-In this retrospective study, approximate to 440 patients receive d mitral valve replacements with the St Jude Medical prothesis. The last pa tient was operated on 10 years before the beginning of the follow-up. The e xtended follow-up was 19 years. Methods and Results-Four hundred forty patients (sex ratio, 1.32 [men to wo men]; age, 60 +/- 11.4 years; age range, 7 to 75 years) were operated on fr om 1979 to 1987. All patients underwent isolated mitral valve replacement. Tricuspid plasty was the only associated procedure. The follow-up at 19 yea rs was 98% complete. The overall actuarial survival rate was 63 +/-3.3% at 19 years, and the actuarial survival rate (only valve related) was 83 +/-2. 7%. The operative mortality rate (0 to 30 days) was 4.09%. We found that 89 .4% of the patients alive at 19 years were in NYHA class I/II. Multivariate analysis showed that age and sex were significantly correlated with valve- related mortality and that age, sex, NYHA class, and atrial fibrillation we re significantly correlated with overall mortality. The linearized rates (p ercent patient-years) of thromboembolism, thrombosis, and hemorrhage were 0 .69, 0.2, and 1, respectively. At 19 years, freedom from endocarditis and r eoperation was 98.6 +/-1% and 90 +/-3%, respectively. Conclusions-In this study, the very-long-term results confirm the excellent durability of the St Jude Medical prosthesis in the mitral position and sh ow the difficulty of adjusting the anticoagulation protocol, even after lon g-term treatment.