Title: Feasibility and Complications of the St. Jude Medical Mechanical Heart Valve- A Brief Study

Authors: Dr Tasneem Muzaffar, Dr Nasir U Din Wani, Dr Syed Abir Hussain, Dr Tufela Shafi, Dr Shyam Singh, Dr Ghulam Nabi Lone

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.92

Abstract

Background: The St. Jude Medical bileaflet mechanical valve was designed by Xinion (Chris) Posis and Donald Hanson who came up with the concept of a leaflet-tab rotating in a “butterfly recess” in the inner wall of the housing with the hinge mechanism located near the central axis of the housing. The bileaflet configuration provided central, evenly distributed flow patterns with small areas of flow separation, minimal flow resistance, low profile, large effective orifice area, and ease of surgical implantation. The valve leaflets and housing were made of pyrolitic carbon and the sewing cuff of double velour dacron. The valve satisfies many of the features of an ideal valve such as long-term durability, non thrombogenicity and hemodynamic efficiency. However, its clinical dependence on chronic anticoagulation persists.

Methods: Between January 2003 to December 2014, 430 patients were studied who had undergone or underwent mitral valve, aortic valve or double valve (both aortic and mitral) replacement with the St. Jude Medical bileaflet valve.

Results: A total of 430 cases were studied. The mean age of operation was 39.16± 9.7 years. The operative mortality rate was 5.5% overall. The average period of follow-up was 4.21± 3.2 years. Structural valve deterioration was not seen in any patient in the series. Nonstructural valve dysfunction was reported in 7 patients. Clinically significant hemolysis was not seen in any patient. Thromboembolism was reported in 22 patients. Valve thrombosis was reported in 3 patients. Major bleeding events requiring hospitalization or transfusion were reported in 17 patients. PVE was reported in 4 patients. There were 36 late deaths. 21 patients died of valve related causes, 9 from cardiac causes and 6 patients from non-cardiac causes. Overall survival rate was 90.66%.

Conclusions: Even though the St. Jude Medical bileaflet mechanical valve satisfies most of the features of an excellent mechanical valve substitute, the late valve related complications (especially thromboembolism and bleeding) and mortality, although low, illustrate that our quest for a “perfect” prosthesis remains.

Keywords: St. Jude valve, Mechanical valve, Morbididty, Mortality.

References

  1. Hufnagel CA. Aortic plastic valvular prosthesis. Bull Georgetown Univ Med Center 1951;5:128–30.
  2. Vincent L. Gott, Diane E. Alejo and Duke E. Cameron. Mechanical heart valves: 50 years of evolution. Ann Thorac Surg 2003;76:2230-2239
  3. John H. Wang The design simplicity and clinical elegance of the St. Jude Medical heart valve Ann ThoracSurg 1989;48:55-56.
  4. Dwight Emary Harken Heart valves: Ten commandments and still counting Ann ThoracSurg 1989;48:18-19.
  5. Edmunds Jr LH, Clark RE, Cohn LH, et al. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann ThoracSurg 1996;62(3):932-5.
  6. Kit V. Arom, M.D., Demetre M. Nicoloff, M.D., Thomas E. Kersten, M.D., William G. Lindsay, M.D., and William F. Northrup, III, M.D. St. Jude Medical Prosthesis: Valve-Related Deaths and Complications. Ann ThoracSurg 43:591-598, June 1987
  7. Kuboyama I, Sese A, Masaki H, Kohda Y, Ueno Y, Imoto H. Early and late results of St. Jude Medical prosthesis in aortic and mitral portion.RinshoKyobuGeka. 1989 Aug; 9(4):374-80
  8. Shigeaki Aoyagi, MD, AtsushigeOryoji, MD, Yoshikatsu Nishi, MD, Ko Tanaka, MD, Kenichi Kosuga, MD, KirokuOishi, MD. Long-term results of valve replacement with the St. Jude Medical valve J Thorac Cardiovasc Surg 1994;108: 1021-1029.
  9. Javier Fernandez, MD, Glenn W. Laub, MD (by invitation), Mark S. Adkins, MD (by invitation), William A. Anderson, MD (by invitation), Chao Chen, PhD (by invitation), Bridget M. Bailey, BSN (by invitation), Linda M. Nealon, BSN (by invitation), Lynn B. McGrath, MD. Early and late-phase events after valve replacement with the St. Jude Medical prosthesis in 1200 patients J Thorac Cardiovasc Surg 1994;107:394-407
  10. Emery RW, Aaron KV, Kroshus TJ, et al. Decision making in the choice of heart valve replacement in patients aged 60–70 years: twenty-year follow-up of the St. Jude Medical aortic valve prosthesis. J Heart Valve Dis 2001;11(Suppl 1):27–44.
  11. Horstkotte D, Haerten K, Herzer JA, Seipel L, Bircks W, Loogen F. Preliminary results in mitral valve replace ment with the St. Jude Medical prosthesis: comparison with the Björk-Shiley valve. Circulation 1981;64(Suppl):II203-9.
  12. Jean-Paul Remadi, Philippe Bizouarn, Olivier Baron, Oussama Al Habash, Phillipe Despins, Jean-Luc Michaud and Daniel Duveau. Mitral valve replacement with the St. Jude medical prosthesis: a 15-year follow-up Ann Thorac Surg 1998;66:762-767.
  13. Arom KV, Nicoloff DM, Kersten TE, Northrup WF III, Lindsay WG, Emery RW. Ten years’ experience with the St Jude Medical valve prosthesis. Ann Thorac Surg. 1989;47:831-7.
  14. Czer LS, Chaux A, Matloff JM, et al. Ten-year experience with the St Jude Medical valve for primary valve replacement. J ThoracCardiovasc Surg. 1990;100:44-55.
  15. Khan S, Chaux A, Matloff J, et al. The St Jude Medical valve.Experience with 1000 cases. J ThoracCardiovasc Surg. 1994;108: 1010-20.
  16. Chaux A, Czer LS, Matloff JM, DeRobertis MA, Stewart ME, Bateman TM, Kass RM, Lee ME, Gray RJ. The St. Jude Medical bileaflet valve prosthesis.A 5 year experience.  J ThoracCardiovasc Surg. 1984 Nov;88(5.1):706-17
  17. Eugene M. Baudet, Vincent Puel, John T. McBride, Jean-Philippe Grimaud, François Roques, Frederic Clerc, Xavier Roques, Nadine Laborde . Long-term results of valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1995;109:858-70.
  18. Kit V. Arom, M.D., Demetre M. Nicoloff, M.D., Thomas E. Kersten, M.D., William G. Lindsay, M.D., and William F. Northrup, III, M.D. St. Jude Medical Prosthesis: Valve-Related Deaths and Complications. Ann ThoracSurg 43:591-598, June 1987.
  19. Arom KV, Emery RW, Nicoloff DM, Petersen RJ. Anticoagulant related complications in elderly patients with St Jude mechanical valve prostheses. J Heart Valve Dis. 1996;5:505-10.
  20. Horstkotte D, Schulte HD, Bircks W, Strauer BE. Lower intensity anticoagulation therapy results in lower complication rates with the St Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1994;107:1136-45
  21. Remadi JP, Baron O, Roussel C, et al. Isolated mitral valve replacement with St Jude Medical prosthesis: long-term results: a follow-up of 19 years. Circulation. 2001;103:1542-5.
  22. Lund O, Nielsen SL, Arildsen H, Ilkjaer LB, Pilegaard HK. Standard aortic St Jude valve at 18 years: performance profile and determinants of outcome. Ann Thorac Surg. 2000;69:1459-65.

Corresponding Author

Dr Tasneem Muzaffar

Consultant CVTS, GMC, Srinagar, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Telephone no: 91-7006838376