Volume 91, Issue 4, Pages (April 1987)

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Presentation transcript:

Volume 91, Issue 4, Pages 503-514 (April 1987) Comparative Clinical Experience with Porcine Bioprosthetic and St. Jude Valve Replacement Lawrence S.C. Czer, M.D., F.C.C.R, Jack M. Matloff, M.D.F.C.C.P., Aurelio Chaux, M.D., F.C.C.P., Michele A DeRobertis, R.N., Richard J. Gray, M.D., F.C.C.P. CHEST Volume 91, Issue 4, Pages 503-514 (April 1987) DOI: 10.1378/chest.91.4.503 Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 1 Freedom from structural failure in porcine and St. Jude valve recipients, shown actuarially by the lines at the top of the figure, referenced to the scale at the left. The box insert depicts the percentage of patients free of failure at 30 days, one year and five years. The yearly linearized event rates are depicted as bar graphs and are referenced to the scale at the right. No structural failures occurred in the St. Jude valve recipients. Numbers below the figure indicate patients at risk during follow-up. CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 2 Freedom from structural failure in porcine valve recipients, stratified by valve position. There was an accelerated rate of failure in mitral bioprostheses after four years of follow-up and in aortic bioprostheses after six years. CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 3 Freedom from embolism in porcine and St. Jude valve recipients. At five years, 92 ± 2 percent of patients in each prosthetic valve group were free of embolic complications (p = NS). CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 4 Freedom from hemorrhagic complications. St. Jude valve recipients experienced significantly more bleeding episodes than did porcine recipients (p <.01). CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 5 Freedom from hemorrhagic complications in patients maintained on warfarin anticoagulation. After five years of follow-up, there was no significant difference in the frequency of warfarin-related bleeding in porcine and St. Jude recipients. CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 6 Actuarial freedom from all valve related complications in porcine and St. Jude valve recipients. Valve related complications occurred equally frequently with both prostheses (p = NS). CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 7 Actuarial survival in porcine and St. Jude valve recipients. All mortalities (early and late) were included in the analysis. There was no difference in survival after five to six years of follow-up. CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 8 Freedom from valve related death. At six years, the actuarial rates were nearly identical (93 ±2 percent vs 94 ±2 percent, porcine vs St. Jude). CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions

Figure 9 Preoperative and postoperative New York Heart Association functional class in porcine (upper panel) and St. Jude (lower panel) valve recipients. Patients who died during follow-up (hatched areas) were concentrated in the more advanced functional classes preoperatively. CHEST 1987 91, 503-514DOI: (10.1378/chest.91.4.503) Copyright © 1987 The American College of Chest Physicians Terms and Conditions