• Journal of Chest Surgery
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• v.25 no.2
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• pp.137-148
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• 1992

Until March 1991, 435 St. Jude Medical valves and 330 CarboMedics valves were implanted in 358 and 251 patients, respectively. 300 patients were male and 309 were female with the mean age of 35.6 years[from 2 month to 68 years]. 458 valves were implanted in the mitral, 272 in the aortic, 25 in the tricuspid, and 10 in the pulmonic position. Postoperatively, all patients except for very young patients were given coumadin with or without dipyridamole for anticogulation Operative mortality was 7.3%[45 deaths per 618 operations]. A total follow-up of 1244.8 patient-years was achieved for the operative survivors with a follow-up rate of 96.8%, [mean follow-up period=26.3 months /patient, ranging from 1 to 80 months]. Functional improvement was evident; 66.7% of these patients were in NYHA functional class III or IV preopratively, whereas 98.4% are in class I or II pos-toperatively. There occurred 13 late deaths[7 valve-related] and 55 valve-related complications. Linearized rates of late death and valve-related complications were 1.0%/ patient-year, 4.42%/patient-year, respectively. Rates of thromboembolism, anticoagluation-related hemorrhage were 1.12%/patient-year, 1.69% /patient-year, respectively. Actuarial survival at 5 years is 96.0% and complication-free survival at 5 years is 83.9%. No difference in survival and incidence of complications was found between the St. Jude and CarboMedics valves. On the basis of this experience, we believe that the pyrolytic carbon bileaflet mechanical valves are safe and preferable choice among current valve prostheses.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.817-821
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• 1995

The CarboMedics Medical valve has become our mechanical valvular prosthesis of choice because of favorable hemodynamic results that associated with marked clinical improvement and low incidence of thromboembolism after it,s uses. The data for this study was collected from August 1988 to July 1993,five years period. There were total of 57 patients[female 40,male 17 in this series with 4 isolated aortic valve,26 isolated mitral valve,11 double valve and a triple valve replacement. The mean follow up time was 32 months. Postoperatively,58% of cases were in New York Heart Association[NYHA functional class I,and mild and moderate symptoms[NYHA class II were present in 36% and there were very few patients remaining in higher functional classes. In postoperative echocardiographic study, showed marked improved cardiac function. The overall early mortality was 3.5% and the late mortality was one case after triple valve replacement due to sudden death. The causes of early death were attributed to early prosthetic valve endocarditis and heart failure.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1102-1110
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• 1996

Between Oct. 1985 and July 1995, 230 patients underwent mitral valve replacement. There were 77 men and 153 women whose mean age was 35.7 years, range 9 to 62 The concomitant operations were 40 aortic valve replacements(17.4%), 25 tricuspid annuloplasties(10.4%), 8 aortic valve replacements & tricuspid annuloplasties(3.5%), 2 tricuspid valve replacements(0.9%) and others, We used 139 mechanical (76 51. Jude medical, 33 CarboMedics, 30 Sorin) and 91 tissue 386 Carpentier-Edwards, 5 lonescu-Shiley) valves. The early postoperative complications occurred in 28 cases. There were 8 low cardiac output syndrome, 5 pleural effusion, 3 significant arrhythmia, 2 cardiac rupture and others. There were 6 early hospital deaths (2.6%) due to low cardiac output syndrome(2), arrhythmia(2) and ventricul r rupture(2). The cuAmulative notal follow-up period was 764. 4 patient-years with a mean of 4).9 months. The long term follow-up information was available for 212 patients(94.6%). There were 21 cases of valve-related complications. Prosthetic valve failure(10), anti-coagulation related bleeding (5), prosthetic valve endocarditis (4), and thromboembolism (2) occurred at rates of 1.3, 0.7, 0.5, and 0.3%Ipt-yr respectively. Late death occurred In 5 cases (0.7%/pt-yr) associated with prosthetic valve endocarditis (2), heart failure (2) and anti-coagulation related bleeding (1). There was no difference in the rate of freedom from prosthetic valve failure between the mechanical and tissue valve group at 6 years (100%), but there was significant difference at 9 years between the tissue (34.4%) and mechanical valve (100%) group (p=0.032). Actuarial survival rates were 98. 8% in tissue valve. 9).7% in mechanical valve group and 96.6% in total patients at 9 years.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.262-269
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• 1999

Background: To review the middle and long term results of aortic valve replacement(AVR) for 11 years, we surveyed and followed up the patients who underwent AVR. Material and Method: Between Feb. 1986 and May 1997, 134 patients underwent AVR. The patients consisted of 71 men and 63 women whose mean age was 38.9 years, ranging from 17 to 70. Result: The concomitant operations were 62 mitral valve replacement(MVR), 14 MVR + tricuspid valve annuloplasty, 10 Cabrol operation, 16 aortic annulus widening, and so forth. We used 119 mechanical(75 St. Jude Medical, 38 CarboMedics, 6 Sorin) and 15 tissue (Carpentier-Edwards) valves. Early postoperative complications occurred in 35 cases; 9 congestive heart failure, 6 low cardiac output, 5 postoperative bleeding, 5 pleural effusion, and so forth. There were 13 early postoperative deaths(9.7%) due to low cardiac output(5), CHF (2), disseminated intravascular coagulopathy(2), and so forth. The cumulative total follow-up period was 452.7 patient-years with a mean of 3.4${\pm}$3.1 years/patient. There were 9 cases of valve-related complications; anticoagulant-related bleeding(4), prosthetic valve endocarditis(2), thromboembolism(2) and prosthetic valve failure(1) occured at rate of 0.9, 0.4, 0.4, 0.2%/ pt-yr, respectively. Late valve-related death occurred in 3 cases(2.0%/pt-yr) associated with anticoagulant-related bleeding(2) and prosthetic valve endocarditis(1). Conclusion: Actuarial survival rate by Kaplan-Meier method was 91.0${\pm}$4.3 % at 11 years.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.900-905
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• 2006

Background: Homografts and bioprostheses are most commonly used for Rastelli operation in congenital heart disease, but the limited durability is responsible for multiple reoperations associated with increased morbidity This study evaluated long-term results after Rastelli operation with a mechanical valved conduit. Material and Method: A total of 20 patients underwent Rastelli operation with mechanical valved conduit from January 1990 to July 1992. Operative mortality was 1 of 20 patients, and a retrospective review of 19 patients(10 males, 9 females) was done. Initial diagnosis was congenitally corrected transposition of great arteries(cc-TGA, n=4), complete TGA (n=2), ventricular septal defect with pulmonary atresia(VSD with PA, n=9), truncus arteriosus(n=2), double outlet right ventricle with pulmonary stenosis(DORV with PS, n=2). The mean age at Rastelli operation was $4.6{\pm}3.4$ years, and mean follow-up period was $12.8{\pm}2.7$ years. Patients underwent Rastelli opearation using 16 CarboMedics mechanical valve, and 3 Bjork-Shiley mechanical valve($17{\pm}2$ mm). Result: There were 15 reoperations for failed mechanical valved conduit. The freedom from reoperation at 5 and 10 years was 53% and 37%. Most patients were received oral anticoagulation with warfarin, and maintained the international normalized ratio(INR) of 1.5 to 2.0. There was no anticoagulation or thromboembolism related complication. There was a significant difference in the causes of a conduit failure between early(within 3 years) and late(after 3 years) failure groups. The six patients reported early prosthetic valve failure, mainly due to valvular dysfunction by thrombosis or pannus formation. The other nine patients reported late prosthetic valve failure, mainly due to dacron conduit stenosis at anastomosis sites, whereas their valvar motion was normal except 1 patient. Conclusion: To avoid early prosthetic valve failure, strict anticoagulation therapy would be helpful. About the late development of obstructive intimal fibrocalcific peels within the Dacron conduit, an improvement of conduit material is necessary to reduce late prosthetic valve failure. In selected patients, the long term results were satisfactory.

• Journal of Chest Surgery
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• v.25 no.2
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• pp.149-157
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• 1992

Total 145 cases mitral vlave replacement were performed in Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from May 1983 to July 1991. Sixty-one patients were male and 84 patients were female and the range of age was from 12 to 66 years old with the mean of 37.9[$\pm$11.6] years. Valvular lesions were 49 cases of mitral stenosis, 18 cases of regurgitation and 78 cases of combined lesion. Used valve were Ionescu-Shiley[42 cases], Bjork-Shiley[49 cases], Inact[6 cases], St. Jude Medical[11 cases] and CarboMedics[37 cases]. Mean size of valve was 29.8$\pm$1.68mm. Early morality was 13.8%[20 cases] and low output syndrome was most common cause[9 cases]. Age, functional classification and biventricular hypertrophy were risk factors. All survived cases were followed up without missing. Mean follow up period were 3 years and 3 months. Total 14 cases of death[9.7%] were observed and heart failure, unexplained sudden death and bleeding were the causes in that order. Common late complications were heart failure and bleeding related with anticoagulation. Actuarial survival rate at 5 years was 83$\pm$5.4% in overall, 78$\pm$7.2% in tissue valve group, 87$\pm$6.8% in mechanical valve group. The actuarial freedom rate from thromboembolism at 7 years was 89$\pm$8.3% in overall, 86$\pm$9.9% in tissue valve group and 97$\pm$1.9% in mechanical valve group. Actuarial freedom rate from bleeding at 5 years with anticoagulation was 88.9$\pm$4.2% in overall, 96$\pm$3.9% in tissue valve group, 86$\pm$4.6% in mechanical valve group. Reoperation was done in 3 cases with heart failure with tricuspid regurgitation and thromboembolism in 2 cases. The functional status of survived cases was I or II.