Abstract
The use of the Angell-Shiley porcine xenograft cardiac valve was limited in number at Seoul National University Hospital chiefly because of the cessation of supply from the manufacturer, Forty-eight Angell-Shiley valves along with the 5 other mechanical or tissue valves were used in 46 patients during the period from 1977 to 1980, and a total of consecutive cases was studied for their early and long-term clinical results. The operative mortality rate was 4.3%; no death after single and 2 deaths after double valve replacement within 30 days of surgery. The 44 early survivors were followed up for a total of 171.6 patient-years and a mean of 46.8$\pm$31.1 months. Four died during the follow-up period with a linealized late mortality rate of 2.33%/patient-year. Four patients had experienced 5 episodes of thromboembolism and one died; a linealized incidence of 2.91% emboli/patient-year. A single case each had a bleeding complication related to the anticoagulants, 0.58% bleeding/patient-year, and prosthetic valve endocarditis, 0.58% endocarditis/patient-year. The clinical improvement was excellent by 70% of the survivors having no cardiac symptoms at the end of the follow-up. The actuarial survival rates were 89.9$\pm$4.9% at 5 years and 69.2$\pm$15.0% at 9 years after surgery. The probabilities of freedom from thromboembolic complication were 92.3$\pm$5.5% and 80.9$\pm$9.0% at 5 and 9 years after surgery. And, the probability of freedom from overall valve failure was 83.4$\pm$6.3% at 5 years and it declined sharply down to 55.9$\pm$22.2% at 9th year of the follow-up. These results are comparable with those in the major reports, except a more accelerated and time-related increases in valve failure after 5 or 6 years after operation with the Angell-Shiley valve. The durability of the xenograft tissue valve remains as the most important debate and the need of more durable tissue valves was also discussed.