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Comparative results with the St. Jude Medical and Medtronic Hall mechanical valves
R G Masters1, A L Pipe, V M Walley
1Department of Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada.
Insights
The St. Jude Medical valve showed superior long-term survival rates compared to the Medtronic Hall valve in aortic valve replacement patients. Both mechanical valves demonstrated good freedom from complications like bleeding and thromboembolism.
Area of Science:
- Cardiology
- Biomedical Engineering
- Surgical Innovation
Background:
- Mechanical heart valves are crucial for replacing diseased or damaged native valves.
- The St. Jude Medical and Medtronic Hall valves are widely used prosthetic devices.
- Comparative clinical performance data is essential for guiding surgical choices.
Purpose of the Study:
- To compare the clinical performance of St. Jude Medical and Medtronic Hall mechanical valves.
- To evaluate survival and complication rates following isolated aortic or mitral valve replacement.
Main Methods:
- Retrospective analysis of 814 patients undergoing isolated aortic or mitral valve replacement between 1984 and 1993.
- Implantation of 349 St. Jude Medical valves and 465 Medtronic Hall valves.
- Actuarial analysis of survival, freedom from bleeding, thromboembolism, and reoperation rates.
Main Results:
- At 5 years, St. Jude Medical valves showed significantly higher survival probability for aortic valve replacement (86% vs. 68%, p=0.0001).
- No significant differences were observed in survival for mitral valve replacement (75% vs. 70%, p=0.54).
- Both valves demonstrated excellent freedom from bleeding, thromboembolism, and reoperation, with no structural valve failures.
Conclusions:
- The St. Jude Medical valve offers superior long-term survival in aortic valve replacement compared to the Medtronic Hall valve.
- Both mechanical valves provide acceptable clinical outcomes regarding complications and reoperation.
- Further research may explore long-term durability and patient-specific factors influencing outcomes.
Abstract:
This study compared the clinical performance of the St. Jude Medical and Medtronic Hall mechanical valves in isolated aortic or mitral valve replacement. From 1984 to 1993, 349 St. Jude Medical valves (aortic 237, mitral 112) and 465 Medtronic Hall valves (aortic 272, mitral 193) were implanted in 814 patients at the University of Ottawa Heart Institute. The patients had similar preoperative characteristics. The hospital mortality rate for aortic valve replacement was 3.4% with the St. Jude Medical valve and 5.8% with the Medtronic Hall valve (p = 0.26) and the rate for mitral valve replacement was 8.9% with the St. Jude Medical valve and 11.9% with the Medtronic Hall valve (p = 0.54). Actuarial estimates of survival and freedom from complications were calculated. At 5 years the actuarial probability of survival (including hospital deaths) for aortic valve replacement was 86% +/- 3% with the St. Jude Medical valve and 68% +/- 4% with the Medtronic Hall valve (p = 0.0001) and for mitral valve replacement was 75% +/- 7% with the St. Jude Medical valve and 70% +/- 4% with the Medtronic Hall valve (p = 0.54). The most common cause of late death was cardiac failure and no deaths were caused by structural failure. The 5-year probability of freedom from bleeding after aortic valve replacement was 99% +/- 1% with the St. Jude Medical valve and 95% +/- 2% with the Medtronic Hall valve (p = 0.06) and after mitral valve replacement 99% +/- 1% with the St. Jude Medical valve and 97% +/- 2% with the Medtronic Hall valve (p = 0.37). The 5-year probability of freedom from thromboembolism after aortic valve replacement was 88% +/- 4% with the St. Jude Medical valve and 81% +/- 3% with the Medtronic Hall valve (p = 0.08) and after mitral valve replacement was 85% +/- 7% with the St. Jude Medical valve and 77% +/- 5% with the Medtronic Hall valve (p = 0.17). Reoperation was uncommon and there were no cases of structural valve failure. The 5-year actuarial estimate of freedom from reoperation therefore for aortic valve replacement was 99% +/- 1% with the St. Jude Medical valve and 96% +/- 2% with the Medtronic Hall valve (p = 0.09) and for mitral valve replacement was 98% +/- 2% with the St. Jude Medical valve and 95% +/- 3% with the Medtronic Hall valve (p = 0.40).(ABSTRACT TRUNCATED AT 400 WORDS)