The St. Jude Medical cardiac valve prosthesis: a 25-year experience with single valve replacement.

Background: From October 1977 to October 2002, 4,480 patients (age range, 17 to 94 years; average, 64 +/- 13 years) underwent single valve replacement with the St. Jude Medical heart valve. Of 2,982 aortic (AVR) and 1,498 mitral valve replacements (MVR), concomitant coronary artery bypass grafting was performed on 42% and 33%, respectively.

Five-year follow up of the ATS mechanical heart valve.

Background And Aim Of The Study: Between January 1, 1997 and December 31, 2001, a total of 342 patients underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) with the ATS Medical prosthesis. The initial three-year phase of this study took place under a United States Food and Drug Administration-approved investigational device exemption study. The study aim was to determine the incidence of valve-related events in up to five years of follow up after valve implantation, and to assess patient disturbance from valve noise.

Opposite trends in coronary artery and valve surgery in a large multisurgeon practice, 1979-1999.

Background: Trends in coronary artery bypass (CAB) and valve operations (VO) may help predict the future of cardiac surgery in the context of changing case mix, shifting paradigms, emerging technology, and population demographics.

Methods: We retrospectively reviewed all 30,319 adult CAB and VO in our group from 1979 to 1999 according to specific procedures.

Results: Coronary artery bypass volumes peaked in 1996 at 1,895 cases, declining 15.

Replacement of the aortic valve in patients under 50 years of age: long-term follow-up of the St. Jude Medical prosthesis.

Background: Aortic valve replacement in the young adult (aged 18 to 50 years) is a choice between a mechanical prosthesis with attendant lifelong anticoagulation or biological prostheses of varying types that may have limited life expectancy in this age group.

Methods: The Cardiac Surgical Research Foundation database was accessed to determine long-term outcomes in patients having aortic valve replacement with the St. Jude Medical Valve.

Trends in aortic valve surgery in a large multi-surgeon, multi-hospital practice, 1979-1999.

Background And Aim Of The Study: Trends in aortic valve operations (AVO) may help to predict the future of aortic valve surgery in the context of changing case mix, population demographics, emerging technology and shifting paradigms.

Methods: All adults undergoing single AVO between 1979 and 1999 were reviewed retrospectively according to age, gender and other typical clinical variables, surgical complexity, specific operation and immediate outcome.

Results: There were 3,917 single AVO.

Is low-intensity anticoagulant therapy possible with an open pivot valve?: analysis of its development.

In 1976, the authors became the codevelopers of the first successful bileaflet heart valve which has become the standard in valvular surgery. However, there still remains a significant rate of thromboembolism and thrombosis which can be attributed to the inherent design of cavities in the pivot area. These cavities contribute to stagnant areas that lead to thrombus formation.

Decision-making in the choice of heart valve for replacement in patients aged 60-70 years: twenty-year follow up of the St. Jude Medical aortic valve prosthesis.

Background And Aim Of The Study: The choice of a cardiac valve for patients with aortic valvular pathology remains controversial. Younger patients may be at risk for long-term complications from chronic anticoagulation yet require prosthesis longevity, while older patients may not outlive a bioprosthesis. To gather information to help decision-making, the 20-year experience of aortic valve replacement (AVR) with the St.

The initial United States experience with the ATS mechanical cardiac valve prosthesis.

From January 1, 1997 through June 30, 2000, 224 patients underwent valve replacement with the ATS Medical cardiac valve prosthesis under a USFDA-approved investigational device exemption study. Aortic valve replacement (AVR) was conducted in 152 patients (39 with coronary bypass) and mitral replacement (MVR) in 72 patients (18 with coronary bypass). Overall operative mortality was 1.

Clinical evaluation of the on-line Sensicath blood gas monitoring system.

Background: Blood gas analysis is an integral part of the management of open heart surgery and post-surgical intensive care patients. This study was conducted to compare the results of on-line blood gas analysis using the new Sensicath (SC) optical sensor technology against standard blood gas assay.

Methods: Comparative blood gas analysis was performed on 45 postoperative cardiovascular surgical patients and 5 patients during cardiopulmonary bypass.

Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity?

Background: Off-pump coronary artery bypass (OPCAB) is an emerging procedure. It is assumed that elimination of cardiopulmonary bypass for coronary artery bypass grafting has the potential for reducing postoperative morbidity. This review evaluates the safety and impact of multivessel OPCABG as compared to CABG.

Minimally invasive direct coronary artery bypass grafting: experimental and clinical experiences.

Background: This communication briefly details the goals, indications, surgical approaches, and limitations of minimally invasive direct coronary artery bypass grafting (MIDCABG). The experimental experiences from various institutions are summarized.

Methods: The clinical experiences of 72 consecutive MIDCABG procedures performed at our institutions between June 5, 1995, and August 13, 1996, were analyzed.

Anticoagulant related complications in elderly patients with St. Jude mechanical valve prostheses.

Background And Aims Of The Study: This communication reports the anticoagulant-related complications (ARH) in patients who received the St. Jude Medical mechanical prosthesis and were 70 years of age or older at the time of implantation.

Methods: Our institutional data file shows that during the 15-year period from 1977 to 1992, our group implanted the St.

North American experience with the Perma-Flow prosthetic coronary graft.

Background: The Perma-Flow prosthetic coronary graft is a 5-mm polytetrafluoroethylene tube into which is incorporated a Venturi flow restrictor. An aorto-superior vena caval fistula is created and coronary anastomoses are constructed proximal to the resistor in side-to-side fashion, where arterial pressure is maintained. From November 1992 through December 1995, eight investigational centers in North America have implanted this graft in 40 patients with inadequate autologous alternatives.

Utilization of the St. Jude Medical prosthesis in the aortic position.

Intensive in vitro and in vivo studies led to the clinical introduction of the St. Jude Medical (SJM) prosthesis in October 1977. Because of excellent clinical characteristics, handling, and durability, as well as the low incidence of clinically adverse events, the SJM valve has become the most commonly used prosthetic heart valve.

Mini-sternotomy for coronary artery bypass grafting.

This communication details the approach to the left anterior descending artery, right coronary artery, or both via a single limited incision of the chest. The mini-sternotomy incision is 10 to 12 cm long. The distal anastomosis can be accomplished, with a beating heart, through this small incision, with or without cardiopulmonary bypass.

Long-term follow-up of the St. Jude Medical prosthesis in pediatric patients.

Background: The St. Jude Medical prosthesis has become the most commonly used artificial heart valve, yet few data are available in the pediatric population. This study addresses results of the use of this prosthetic valve in pediatric patients over a 13-year time frame.

Modification of the elephant trunk procedure for treatment of acute aortic dissection.

The distal anastomosis constructed during repair of an aortic dissection is prone to bleeding, reentry, and neodissection. To protect the hemostasis, a modification of Borst's elephant trunk procedure has been devised. This "mini-trunk" protects the anastomosis with an internal buttress using the crease of an infolded graft and with a short flap of graft everted into the distal lumen preventing access of the blood stream to this newly constructed suture line.

Operative considerations in implantation of the Perma-Flow graft.

The Perma-Flow coronary bypass graft (Possis Medical, Inc, Minneapolis, MN) currently is undergoing expanded clinical trial. From November 1992 through June 1994 we have used this artificial conduit in 8 patients without autologous alternatives. These cases allowed the establishment of a technical basis for successful implantation of this graft.

First clinical use of the Possis synthetic coronary graft.

The Possis polytetrafluoroethylene Permaflow coronary graft incorporates a Venturi resistor within the graft. Insertion is constructed by creating an anastomosis to the superior vena cava with subsequent anastomoses in sequence to coronary arteries requiring grafting. Finally, the graft is sewn to the aorta.

Mechanical circulatory support as a bridge to transplantation.

From December 1985 through April 1988, 11 patients (three female and eight males), 33.1 +/- 3.9 (+/- SEM) years of age (range, 15 to 50 years), underwent heart transplantation preceded by the use of mechanical circulatory support.

Ten-year follow-up study of patients who had double valve replacement with the St. Jude Medical prosthesis.

Records of 100 consecutive patients who had received double valve replacement were reviewed (41 men, 59 women, mean age, 60.86 +/- 13.0 years).

Ten years' experience with the St. Jude Medical valve prosthesis.

Records of 1,298 consecutive patients who had received the St. Jude Medical prosthesis were reviewed (713 male and 585 female patients; mean age, 61.79 +/- 13.

Aorta balloon angioplasty: 9-year follow-up.

Nine-year patency and clinical effectiveness of balloon angioplasty of the aorta in a patient with Leriche syndrome are described. The morbidity of surgical intervention for aortoiliac disease is compared with that of percutaneous transluminal angioplasty. These results suggest that aortic balloon angioplasty is a safe and effective procedure with good long-term results.