The St. Jude "Silzone" valve: Midterm results in treatment of active endocarditis

Background. The Silzone-coated St. Jude Medical valve (SJM "Silzone" valve) , developed to reduce prosthetic valve endocarditis (PVE), was recalled by SJM due to a higher rate of paravalvular leaks. The aim of this study was t o determine the efficacy of the SJM "Silzone" valve in avoiding PVE and to evaluate the frequency of paravalvular leaks, when the valve was used exclu sively for active bacterial endocarditis. Methods. From January 1998 to December 1999, the SJM "Silzone' valve was im planted in 40 consecutive patients with active endocarditis (20 aortic, 14 mitral, and 6 both valves). Late transesophageal echo cardiography was perf ormed in 87% of survivors, and transthoracic echocardiography in the remain ing 13%. Follow-up was 100%. Results. Hospital mortality was 17.5%. Early PVE occurred in 2 of 40 patien ts (5%). There were two late deaths without signs of recurrent PVE. A hemod ynamic relevant paravalvular leak necessitating reoperation was seen in 2 p atients within 6 months after operation. The rate of a minor paravalvular l eak was 13% (4 of 31 patients). Conclusions. The SJM "Silzone" valve when implanted for active bacterial en docarditis does not give better results than other mechanical prostheses wi th regard to early recurrence of endocarditis. The rate of a hemodynamic re levant paravalvular leak requiring reoperation. seems rather high during th e early postoperative period, whereas the occurrence of minor paravalvular leaks is comparable with that of other mechanical prostheses. Routine obser vation, recommended for all patients with mechanical heart valves, is also sufficient for patients with the SJM "Silzone" valve. (C) 2001 by The Socie ty of Thoracic Surgeons.