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Hemodynamic and hemolytic features of the St. Jude Medical valve prostheses
Insights
The St. Jude Medical valve demonstrated superior hemodynamic function and zero thromboembolic complications in valvular replacement surgery. This central flow mechanical valve shows great promise for patients needing cardiac valve prostheses.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Heart Valves
Background:
- Valvular heart disease necessitates prosthetic valve replacement.
- Mechanical heart valves offer durability but can have hemodynamic limitations.
- Early mechanical valves like Starr-Edwards (S.E.) and bioprosthetic valves like Carpentier-Edwards (C.E.) have known performance characteristics.
Purpose of the Study:
- To evaluate the clinical performance of the St. Jude Medical valve, a bileaflet mechanical prosthesis.
- To compare the St. Jude Medical valve's function and hemolysis with S.E. valves, C.E. valves, and open mitral commissurotomy.
Main Methods:
- Retrospective analysis of 86 patients (108 valves) who underwent valvular replacement with St. Jude Medical valves between July 1978 and July 1981.
- All patients received anticoagulant therapy.
- Postoperative clinical evaluation included valve function (pressure gradients, orifice area) and hemolysis, compared against historical data from S.E. valves, C.E. valves, and open mitral commissurotomy.
Main Results:
- The St. Jude Medical valve group exhibited zero incidence of thromboembolic complications.
- Hemodynamic assessment showed the St. Jude Medical valve yielded the best results regarding left atrioventricular diastolic pressure gradient and mitral effective orifice area.
- Valve function was equivalent to open mitral commissurotomy and superior to S.E. and C.E. valves; hemolysis was minimal, second only to C.E. valves.
Conclusions:
- The St. Jude Medical valve demonstrates excellent hemodynamic characteristics compared to other prostheses.
- Its low hemolysis and superior valve function indicate significant promise as a central flow mechanical valve prosthesis.
- The St. Jude Medical valve offers a favorable risk-benefit profile for valvular replacement surgery.
Abstract:
We performed valvular replacement in 86 cases (108 valves, 43 males, 43 females) from July 1978 to July 1981 with St. Jude Medical valves which utilize two discs made of pyrolytic carbon and employ a bileaflet central opening system. Ages ranged from 13 to 68 years (average 42.3). For all cases in this study, we performed anti-coagulant therapy. The incidence of thromboembolic complication was zero. With regard to postoperative clinical evaluation on valve function and chronic hemolysis, we compared the cases of St. Jude Medical valves with those of Starr-Edwards (S.E.) valves (aortic: Model 2320, mitral: Model 6400), Carpentier-Edwards (C.E.) valves and cases of open mitral commissurotomy. As for valve function such as left atrioventricular diastolic pressure gradient, mitral effective orifice area both at rest and on exercise, the St. Jude Medical valve yielded best results. Next was the C.E. and third was the S.E. The results of the St. Jude Medical valve group and those of the open mitral commissurotomy group were equivalent. In comparison with ball type cardiac valve prostheses and bioprostheses, the St. Jude Medical valve has excellent hemodynamic characteristic. Concerning hemolysis, the St. Jude Medical was below only the C.E., however the degree of hemolysis was so low that the St. Jude Medical valve holds great promise as central flow mechanical valve prostheses.