A 6 year experience with the St. Jude Medical Valve: Hemodynamic performance, surgical results, biocompatibility and follow-up

Abstract

After in vitro testing (confirmed in vivo) of three contemporary valve designs (St. Jude, Björk-Shiley and Carpentier-Edwards) demonstrated that the St. Jude valve possessed the most favorable hydrodynamic performance characteristics, a limited clinical trial was begun in high risk patients who might benefit from a prosthesis with improved hemodynamics. Between March 1978 and March 1984, 419 St. Jude prostheses (157 aortic, 156 mitral and 53 double aortic-mitral) were implanted in 366 patients. Ninety-six percent were in New York Heart Association functional class III or IV preoperatively. Early (30 day) mortality was 10.4% overall, and was lower after aortic (5.7%) or double (7.5%) than after isolated mitral valve replacement (16.0%). Forty-four prosthetic mitral valve recipients with severe ischemic mitral regurgitation experienced a 32% early mortality rate; without this group, mitral valve replacement carried a 10% early mortality rate (p less than 0.01). Multivariate logistic regression analysis confirmed that early death was strongly associated with three preoperative patient characteristics (p less than 0.05): ischemic mitral valve disease, depressed left ventricular function (ejection fraction less than 0.55) and advanced functional class (class IV). Late follow-up (7,055 patient-months, mean 22) was 99.7% complete (1 patient lost). Actuarial survival at 4 years was 80, 80 and 79% after aortic, mitral (nonischemic) and double valve replacement, respectively; in the subset with ischemic mitral regurgitation, actuarial survival was 34% (p less than 0.01). Eighty-six percent of survivors were in functional class I or II.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler Echocardiographic Comparison of Small (19 mm) Bileaflet and Pericardial Heart Valve Prostheses in Aortic Position

“…Both the St Jude Medical and the Carbo-Medics bileaflet valves reportedly have a characteristic regurgitation pattern reducing forward flow by 5-10% (7,9,12,21). The same pattern, with one central and two lateral jets, was observed in all but one of our patients with these valves.…”

Doppler assessment of prosthetic valves

“…For tilting-disc valves, maximal velocities are usually found in the major orifice. Bileaflet valves such as the St. Jude have 3 flow orifices with nearly equal maximal velocities [6,7]. Bioprosthetic valves exhibit central flow characteristics, so that their maximal velocities are normally in the middle of the flow jet.…”

“…Most normally functioning mechanical valves produce mild amounts of orifice regurgitation. The largest volumes have been observed with the St. Jude and Bjork-Shiley valves, which produce 5 to 10 ml per beat [6]. Bioprosthetic valves such as the Hancock or Carpentier-Edwards produce much less orifice regurgitation, generally about 1 ml per beat.…”

Hemodynamic rounds series II: Hemodynamic evaluation of a stenotic bioprosthetic mitral valve

“…Although the leaflets of a bioprosthetic valve cannot be visualized, the structural integrity of a mechanical valve, especially the motion of the disk ring or poppet, can indicate dysfunction due to tissue ingrowth or thrombus. Excessive rocking of the base ring may suggest partial dehiscence [7,8]. Cinefluoroscopy has been used to detect the separation of the outlet strut of a BjorkShiley tilting disk valve before complete strut fracture occurs [9].…”