• Journal of Chest Surgery
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• v.21 no.2
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• pp.283-290
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• 1988

St. Jude Medical cardiac valve replacement was performed in 90 consecutive patients from Jan. 1984 to Dec. 1987. 54 had mitral, 12 had aortic and 24 had multiple valve replacement. Follow up extended for 1 to 47 months[mean 17.1 month] with a cumulative period of 1351 months. The overall actuarial survival rate at 4 years was 87.1% and overall hospital mortality was 6.7%. The linearlized incidence of thrombotic obstruction, thromboembolism, valve failure was 0.8% / pt. yr. each. The lower incidence of valve related mortality or morbidity was statistically significant. The performance of the St. Jude Medical mechanical valve was excellent compared to other substitute valves and has low incidence of thromboembolism or valve failure.

• Journal of Chest Surgery
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• v.25 no.2
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• pp.158-166
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• 1992

From 1985 to 1990, a total of 160 new valves were implanted for 125 adult patients to whom prosthetic valve replacement had been performed [One patient had consecutive 2 reoperations]. Following data are the results from the follow-up study from January 1985 to February 1991. Mean age of the patients was 37.9$\pm$12.1 years. Mean follow-up period was 25.8$\pm$18.8 months. In bioprosthesis, mean interval between the previous operation and reoperation was 85.6$\pm$36.4 months in aortic valve, and 87.3$\pm$30.0 months in mitral valve. The causes of reoperation were prosthetic valve failure[103 patients, 81.7%], prosthetic valve endocarditis[17 patients, 13.5%], periprosthetic leakage[5 patients, 4.0%], and aneurysm of ascending aorta[1 patient, 0.8%]. Fourteen patients[11.1%] died in hospital; 5 in 22 replacement of aortic valve[22.7%], 6 in 73 rereplacement of mitral valve[8.2%], and 3 in 31 replacement of multiple valves [9.7%] Except for 3 intraoperative deaths, postoperative, major and minor complications occurred in 39 patients[31.0%]. And the actuarial 5-year survival rate of operative survivors was 95.5$\pm$8.6%.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.114-121
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• 1994

St. Jude Medical cardiac valve replacement was performed in 135 consecutive patients from Aug.1986 to Dec. 1991.72 had mitral, 28 had aortic, 1 had tricuspid and 34 had double valve replacement. The hospital mortality rate was 4.4% & the late mortality rate was 3.7 %. Follow-up was done on 115 surviving patients:mean follow-up period was 29.78 $\pm$ 18.32 months. Paravalvular leakage was observed in two patients, possible prosthetic valvular endocarditis wasobserved in one patient and other specific valve-related complications were none. The overall actuarial survival rate at 6 years were 91.6% in total, 96.4% in aortic, 95.5 % in mitral and 81.9 % in double valve replacement.We concluded, therefore that good clinical results and a low complication rate could be achieved with St. Jude Medical valve in short-term follow-up & long-term follow-up was also necessary.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1090-1094
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• 1996

From February 1980 to September 1995, 31 children between 2 months and 15 years of age with mitral valve disease have undergone mitral valve replacement(MVR) at Yonsei Cardiovascular Center and com- plete follow-up has been obtained on 28 patients. There were 10 males and 18 females whose weight ranged from 4.9kg to 56kg. Two patients died early postopeiatively and the overall hospital mortality rate was 7.1%. These two were infants but there were no statistically significant difference in overall mortality among the age groups(p=0.13). The valve related complication rate was 57.1% in children younger than 5 years of age, which showed higher complication rate compared to older patients(p< 0.05). The bioprosthetic valve have been applied in 7 patients, and its 5-year valve failure-free survival rate was 50% . No mechanical valve failu e had occurred in 21 patients. In considering high re-replacement rate of bioprosthetic valve, mechanical valve is recommended despite its possibility of bleeding and thromboembolic complications. However, the consequences of increasing body size and long-term interposition of a rigid prosthesis in a growing heart will require second valve replacement. En conclusion, mitral valve replacement can be performed tilth satisfactory long-term survival in children, although younger mean age of the children has an important influence on early mortality and com- plication rate. And therefore mitral valve replacement in children younger than 5 years of age needs special consideration.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.783-787
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• 2005

Eight patients underwvnt reoperation after valve replacement surgery with a mechanical valve from January, 1992 to December, 2003. Among the various indications for reoperation, there were 4 patients with paravalvular leakage; 3 patients underwent resuturing of the area of leakage and one patient underwent redo valve replacement. Among the three patients with stenosis due to thrombosis of the valve, 2 patients underwent redo valve replacement and one patient underwent thrombectomy. In one patient, the valve functioned normally, but stenosis was caused by overgrowth of the patient and redo valve replacement was done 123 months later. There was no postoperative mortality or morbidity. After an average of 51 months ($2\~134$ months) of postoperative follow up, the patients were in good condition and were able to maintain a NYHA functional class of I or II. The operative method used, whether it be a redo valve replacement or valve sparing method, depends upon the type of lesion and the anatomic structure.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.661-671
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• 1992

From March 1988 to May 1991, 140 CarboMedics cardiac valve prostheses[75 mitral, 9 aortic and 28 double aortic-mitral] were implanted in 112 consecutive patients[mean age 36.7$\pm$11.6 years, male/female 48/76] by one surgical team operating on adult cardiac patients at Kyoungpook University Hospital Associated Surgical procedures were performed in 19 patients[16.9%]. Total follow up represented 2,345 patient-months[mean 22.4 months] and was 100% complete. Eighty-two patients[73%] were in NYHA functional class IIIor IV preoperatively and 102 patients [95%] were in class I or II postoperatively. Hospital[30 day] mortality was 4.4%, [3/75 mitral, 1/9 aortic, 1/28 double valve replacement] and late death was 1.7%. [1 /74 mitral, 1 /28 double valve replacement] The actuarial survival at 36 months was 94.0% after mitral, 80% after aortic, 92% after double valve replacement, and 93.2% for the total group. The linearized incidence of valve relater death, prosthetic valve thrombosis, anticoagulant related hemorrhage, and reoperation was 1.00%/pt-yr, 0.51%/pt/yr, 0.51%/pt-yr, and 0.51%/pt-yr respectively. The 36 month rates of freedom from valve replated death, thromboembolism, endocarditis, anti-coagulant related hemorrages, and reoperation were 98.75%, 99.08%, 100%, 99.04%, and 99.08% respectively. The 36 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.2%. These fact suggest that the CarboMedics heart valve has excellent short-term result, low incidence of valve-related complications and valve dysfunction, and additional long term follow up study is necessary.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.189-200
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• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.10-17
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• 1983

Valve replacement in children, aging up to 15 years [Mean 11.g years], has been done at Seoul National University Hospital over the past 14 years since 1968. Fifty-one patients have received 59 artificial valves: 55 bioprosthetic and 4 prosthetic valves. Thirty-one patients [60.8%] had rheumatic heart disease and the remainder [39.2%] had congenital heart disease. Forty-two patients [82.4%] survived operation: 9 patients [17.7%] died within one monfi3 postoperatively and 4 patients [7.8%]during the follow-up period with the overall mortality rate of Thromboembolic complication occurred in 3 patients with 2 deaths: 5.9% embolic rate or 4.68% emboli per patient-year. One patient who had been on coumadin anticoagulation died from cerebral hemorrhage. One mitral Ionescu-Shiley valve failed 19 months after first replacement and this was successfully re-replaced with the same kind of valve. Actuarial survival rate was 59.9% at 4 years after surgery. Thromboembolism-free and valve failure-free survivals were 80.0% and 93.1% respectively. These clinical results in the pediatric age group suggested that valve replacement in children was a serious undertaking with a higher mortality rate than in adults. However, the main superiority on the low thrombogenecity of the xenograft valve over the mechanical one warrants its continuing use until the question of its durability would otherwise be answered by a further study of clinical follow-up.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1055-1060
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• 1992

Clinical experience of 21 patients with infective endocarditis was reviewed. Endocarditis involved the left-sided valve in 16 cases, the right-sided valve in 2, and PDA in the remaining 3 patients. Valve abnormalities included leaflet perforation in 9 patients, chordal rupture in 2,; annular abscess in 6; and aorticoleft atnal perforation in 2. Sixteen patients underwent valve replacement[aortic valve replacement in 7 patients, mitral replacement in 4 and double valve replacement in 5], two had VSD closure with pulmonary valve excision, three had ductus arteriousus closure. The patients were classified into two groups. I ] Healed endocarditis group: including the patients who had completed a planned cou-rseof antibiotic therapy[N=10], II ] Active endocarditis group: patients in which operations were performed prior to completetion of antibiotic treatment course[N=11]. The indications for operation included congestive heart failure, embolism, and persistent sepsis. Organisms were predominantly streptococcus[N=5] and staphylococcus [N=4] followed by candida, moraxella, and E-coli. By NYHA functional classification, all patients were in Class III or IV preoperatively. There was only one operative mortality in patient from group II. All patients substantially, improved postoperatively with NYHA classification in class I or II. This study shows that early surgical intervention in patients with active endocarditis has desirable outcome.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.346-354
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• 1995

Records of 71 consecutive patients who had received multiple valve replacement were reviewed[34male,37female,mean age 40.5$\pm$11.2 <14-63> . The early death rate was 2.8%[2/71 . A completed follow-up rate of 95.7% was accomplished in these 69 patients who left hospital[mean 42.5 $\pm$29.5 patients-years . Five of these patients died. The late death rate was 7.2%. Four patients experienced anticoagulant-related hemorrhage[all were minor . One patient had a thromboembolic episode[permanent ,and 2 had late prosthetic valve endocarditis. There was no clinical evidence of hemolysis and structural failure of valves used. Of those patients who survived,NYHA functional class improved significantly[from 87.2% class III & IV before to 95.8% class I & II after . Linearized rates for thromboembolism and anticoagulant-related hemorrhage,and for prosthetic valve endocarditis were 0.67%/100 patient-years,2.95%/100 patient-years,1.34%/100 patient-years, respectively. The actuarial estimates of incidence free of all complications and valve-related deaths were 92.2%/patient-years.Despites the advanced heart disease involving two or more native valves, the patients who had multiple valve replacement had very good results, over a 9-year period.