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[Long-term experience with multivalve replacement with the Medtronic-Hall mechanical prosthesis]
J L Vallejo1, J M González Santos, J Albertos
1Servicio de Cirugía Cardiovascular, Hospital General Gregorio Marañón, Madrid.
Insights
The Medtronic-Hall (M-H) mechanical heart valve prosthesis demonstrates excellent long-term clinical performance and reliability over 8 years. This study found a low incidence of valve-related complications, highlighting its suitability for valve replacement surgery.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Heart Valves
Context:
- Rheumatic valve disease is a primary indication for heart valve replacement.
- Mechanical heart valves are widely used for long-term hemodynamic support.
- Patient outcomes following valve replacement are influenced by prosthesis type and patient comorbidities.
Purpose:
- To evaluate the clinical performance and mechanical reliability of the Medtronic-Hall (M-H) heart valve prosthesis.
- To assess long-term survival, thromboembolism, endocarditis, and complication rates following M-H valve implantation.
- To compare outcomes between aortic/mitral valve replacement (Group I) and tricuspid valve replacement (Group II).
Summary:
- 182 Medtronic-Hall (M-H) valves were implanted in 89 patients (Group I: 83 patients, aortic/mitral; Group II: 6 patients, tricuspid +/- others).
- Hospital mortality was 6.02% (Group I) and 33.3% (Group II).
- At 8 years, Group I showed actuarial survival of 72.7%, freedom from thromboembolism of 85.8%, and freedom from endocarditis of 93.1%. No structural failures occurred; complications included hemorrhage (6), hemolysis (8), and periprosthetic leaks (2).
Impact:
- The M-H valve prosthesis exhibits excellent clinical performance and mechanical reliability over an 8-year follow-up period.
- The incidence of valve-related complications is comparable to other mechanical prostheses, suggesting favorable long-term outcomes.
- Findings support the M-H valve as a reliable option for patients requiring cardiac valve replacement, particularly for rheumatic valve disease.
Abstract:
During the period from January to September 1986, 182 Medtronic-Hall (M-H) heart valve prostheses were implanted in 89 patients, mainly because of rheumatic valve disease (68.5%). The patients were divided in two groups. Group I consisted of 83 patients with aortic and mitral valve replacement. Six patients with tricuspid valve replacement plus aortic and/or mitral valve replacement constituted group II. In group I the majority of the patients (86.7%) were in functional class III or IV (NYHA). Twenty three patients had undergone at least one previous cardiac operation. Hospital mortality was 6.02% (5/83). In group II the patients were in functional class III or IV (NYHA). Hospital mortality was 33.3% (2/6). Death occurred in the operating room in only one instance. Follow-up was completed in 98.9% and extended from 27 months to 8 years (348.7 patient years in group I and 23.08 patient years in group II). The overall 5 and 8 years actuarial survival, freedom of thromboembolism and freedom from endocarditis rates in group I were: 80.8 +/- 4.4% and 72.7 +/- 5.2%; 89.8 +/- 4% and 85.8 +/- 4.7%; 94.8 +/- 1.2 and 93.1 +/- 1.7%. In group II, actuarial studies were not carried out because of the scanty number of cases. There were another complications in group I: haemorrhage due to anticoagulation in 6 cases, hemolysis in 8 instances and periprosthetic leaks in 2 cases. There were no cases of structural failure. We conclude that after 8 years of follow-up the M-H valve prosthesis shows an excellent clinical performance and mechanical reliability, and the incidence of valve-related complications was in the low range of that reported with other mechanical prostheses.