Experience with bileaflet mechanical valve replacement at the Inha Hospital in 192 patients, operated on from June 1986until April 1993. Two hundred fourty-one prostheses(51 Duromedics, 79 St. Jude Medical, and 111 CarboMedics) were implanted
during the
total 195 operations, Mitral valve replacment(MVR) was done in 113 cases, aortic valve replacement(AVR)in 34, tricuspid valve replacement(TVR)in 2,and double valve replacement(DVR) in 46 cases.
Of the total patients, 63.0% were women and 37.0% were men. The mean age of the patients was 40.8 years, ranged from 14 to 67years. Overall early mortality was 9.2%(18 out of 195);9.7%(11 out of 113)for MVR, 14.7%(5 out of 34)for AVR, and 4.3%(2
out of
46)for DVR. All of the operative survivors were followed over a period of one to 83 months with a mean of 37 months, for total 543 patient-years. So far, eleven patients(6.7% of the long-term survivors) were lost to follow-up after a mean
postoperative
follow-up of 22.8 months. There were nine late deaths; three deaths due to prosthetic valve endocarditis, two due to persistent heart failure, one due to cerebral hemorrhage, one due to aortic dissection after Bentall oreration, and two sudden
deaths.
Actuarial survival rate at 6.9 years was 94.8%, There were seventeen valve-related complications; three prosthetic valve thrombosis, three thrombembolisms, three instances of prosthetic valve endocarditis, two paravalvular leakages, and six
hemorrhagic
complicatios related to anticoagulation. The actuarial rate of freedom from all valve-related complications at 6.9 years was 91.3%. There were significant decreases in the heart size postoperatively that can be demonstrated by comparison of
cardio-thoracic ratios on simple chest X-ray and left ventricle dimensions on echocardiography.
We conclude that this midterm follow-up shows good results in terms of hemodynamics and dura bility although further long-term evaluations are mandatory. (Korean J Thoracic Cardiovas Surg 1993;26:677-85)
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