• Journal of Chest Surgery
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• v.17 no.3
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• pp.346-355
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• 1984

77 cases of Aortic Valve Replacement, which were composed of 64 rheumatic valvular heart disease and 13 combined congenital heart disease, were operated at Seoul National University Hospital for Aortic valvular disease during the period from June 1968 to December 1983. Among these 64 rheumatic aortic valvular heart disease cases, 8 patients were expired during and immediate after operation and overall mortality rate was 12.5%. For more precise remarks, these patients were divided into two periodic groups, 1st period [from 1968 to 1976] and 2nd [from 1977 to 1983] when annual open heart surgery were over 100 cases, and in 1st period three of four patients were died and in 2nd period five of sixty patients were died and its mortality rate was 8.3%. There were 12 cases of postoperative complication, which were 3 cases of remaining other valvular heart disease required MVR, 2 paravalvular leaks [one of them got Redo AVR], 4 thromboembolism or problem of anticoagulant therapy, 2 late death due to SBE with replaced valve failure and one functional AS with small sized valve. Operative death was affected by pump-time and aortic cross-clamping time, heart size, Ejection Fraction, LVEDP and symptom duration, and other many factors may influence the survival rate. Improved operative technique and myocardial protection and meticulous evaluation of the preoperative patient status will make the AVR safer.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.263-267
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• 1995

A total and consecutive 87 patients underwent aortic valve replacement[AVR with the St. Jude Medical prosthesis between 1984 and 1993. Age ranged from 14 to 66 years[mean:38.6$\pm$ 14.0 years .Twenty-one patients [24.1% had undergone previous valve replacement. There were 8 early deaths with an operative mortality rate of 9.2% [7.6% for primary AVR and 14.3 % for re-replacement AVR . Seventy-nine early survivors were,followed for a total of 309.1 patient-years[mean:3.9$\pm$ 2.5 years . A late mortality rate was 5.1% [4 patients or a linearized incidence of 1.294 %/patient-year. All were anticoagulated with coumadin to maintain the international normal ized ratio[INR between 1.5 and 2.5. One patient experienced thromboembolism[0.324%/patient-year , and none did bleeding. Endocarditis occurred in one[0.324%/patient-year . Paravalvular leak was the most frequent complication and was experienced by 8 patients[2.588%/patient-year , and 5 of them required re-replacement AVR[1.618 %/patient year of reoperation rate . There was no structural failure of the prosthesis. Actuarial survival including operative death was 83.9%$\pm$ 4.6% at 10 years.The actuarial estimates of freedom from thromboembolism and of freedom from late death and all complications were 95.1% $\pm$ 4.8 % and 81.4% $\pm$ 6.1%, respectively, at 10 years. These clinical results suggest that less intensive anticoagulation may be allowed for patients of AVR with the St. Jude Medical valve with low incidences of both thromboembolic and bleeding complications.

• Journal of Veterinary Clinics
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• v.34 no.4
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• pp.275-278
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• 2017

An 8-year old female Korean Short Hair cat with a history of paralysis of both hind limbs less than 1 hour before admission was referred. On physical examination, the left hind limb was cold and there was no pulsation or mobility. On abdominal ultrasound examination, a thrombus 8 mm in length was found at the aortic bifurcation. The patient was diagnosed with hypertrophic cardiomyopathy (HCM) and cardiogenic pulmonary edema through radiologic evaluation and echocardiography. A tissue plasminogen activator (tPA) was applied intravenously using an accelerated dosing protocol (1 mg administered intravenously [IV] bolus, 2.5 mg IV over 30 min, 1.5 mg IV over 1 h) to treat the feline arterial thromboembolism. Within 12 h after administration of tPA, pulsation and mobility of both hind limbs were normal, without any noticeable complications. Clopidogrel was prescribed to prevent additional thrombus formation, and pimobendan, benazepril, and furosemide were prescribed for administration at home. The patient was discharged and survived 377 days.

• Journal of Chest Surgery
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• v.24 no.2
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• pp.171-181
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• 1991

Result of St. Jude Medical valve replacement are presented in 106 patients who underwent operation from January 1985 through July 1989. The patient were 52 males and 56 females. Total 136 of St. Jude Medical valves were implanted; 91 in mitral position, 45 in aortic position. The hospital mortality rate was 5.7%o[6 patients] and the late mortality rate was 2.0%[2 patients]. The causes of death were low cardiac output in 5, iatrogenic right ventricular rupture in 1, heart failure in 1, ventricular arrhythmia in l. And, the causes of valve related complication were anticoagulant related hemorrhage in 5 patients[0.03% /patient-year] and thromboembolism[0.01% /patient-year] in 2 patients. In conclusion, the performance of the St. Jude Medical valve compare most favorably with other artificial valves. But it remains still hazards of mechanical prosthesis such as thromboembolism and anticoagulant related hemorrhage.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.960-969
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• 1989

Results of St. Jude Medical valve replacement are presented in 171 patients who underwent operation from January 1983 through June 1989. The patients were 79 males and 92 females with ages ranging from 12 to 71 years. Total 211 of St. Jude Medical valves were implanted: 148 in mitral position, 57 in aortic position, 6 in tricuspid position. The follow-up was from 2 to 76 months with a cumulative period of 375 patient-year. The actuarial survival at 1 year, 3 year and 5 year were 92.1 %, 87.6 % and 86.3% respectively. The linearlized incidences of valve failure, thromboembolism, thrombotic obstruction, anticoagulation related hemorrhage and all valve related complication were as follows: 0.5 %/pt-yr, 0.5 %/pt-yr, 0.5 %/pt-yr, 1.1 %/pt-yr, and 2.4 %/pt-yr, respectively. The performance of the St. Jude Medical valve compares most favorably with other artificial valves. But it remains still hazards of mechanical prostheses such as thromboembolism and thrombotic obstruction.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.283-290
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• 1988

St. Jude Medical cardiac valve replacement was performed in 90 consecutive patients from Jan. 1984 to Dec. 1987. 54 had mitral, 12 had aortic and 24 had multiple valve replacement. Follow up extended for 1 to 47 months[mean 17.1 month] with a cumulative period of 1351 months. The overall actuarial survival rate at 4 years was 87.1% and overall hospital mortality was 6.7%. The linearlized incidence of thrombotic obstruction, thromboembolism, valve failure was 0.8% / pt. yr. each. The lower incidence of valve related mortality or morbidity was statistically significant. The performance of the St. Jude Medical mechanical valve was excellent compared to other substitute valves and has low incidence of thromboembolism or valve failure.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.661-671
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• 1992

From March 1988 to May 1991, 140 CarboMedics cardiac valve prostheses[75 mitral, 9 aortic and 28 double aortic-mitral] were implanted in 112 consecutive patients[mean age 36.7$\pm$11.6 years, male/female 48/76] by one surgical team operating on adult cardiac patients at Kyoungpook University Hospital Associated Surgical procedures were performed in 19 patients[16.9%]. Total follow up represented 2,345 patient-months[mean 22.4 months] and was 100% complete. Eighty-two patients[73%] were in NYHA functional class IIIor IV preoperatively and 102 patients [95%] were in class I or II postoperatively. Hospital[30 day] mortality was 4.4%, [3/75 mitral, 1/9 aortic, 1/28 double valve replacement] and late death was 1.7%. [1 /74 mitral, 1 /28 double valve replacement] The actuarial survival at 36 months was 94.0% after mitral, 80% after aortic, 92% after double valve replacement, and 93.2% for the total group. The linearized incidence of valve relater death, prosthetic valve thrombosis, anticoagulant related hemorrhage, and reoperation was 1.00%/pt-yr, 0.51%/pt/yr, 0.51%/pt-yr, and 0.51%/pt-yr respectively. The 36 month rates of freedom from valve replated death, thromboembolism, endocarditis, anti-coagulant related hemorrages, and reoperation were 98.75%, 99.08%, 100%, 99.04%, and 99.08% respectively. The 36 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.2%. These fact suggest that the CarboMedics heart valve has excellent short-term result, low incidence of valve-related complications and valve dysfunction, and additional long term follow up study is necessary.

• Journal of Veterinary Clinics
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• v.26 no.4
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• pp.362-366
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• 2009

Hypertrophic cardiomyopathy (HCM) is the most often seen type of cardiomyopathy in cats. The cause is unknown but a genetic basis is thought to underlie some cases. Thromboembolism (TE) is a troubling complication in cats with myocardial disease. Two cats referred to Seoul National University Hospital for Animals with the paralysis of bilateral hindlimbs after vomiting. The cats were depressed and the bilateral hindlimbs were cyanotic, cool and painful. Heart murmur sounds were auscultated in both cases. Through radiographic and echocardiographic evaluation, HCM was diagnosed. TE at the distal aortic trifurcation was also visualized on abdominal ultrasonography. Both cats were expired and HCM and saddle thrombus were confirmed by postmortem examination in one cat.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.258-263
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• 2016

Background: The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. Methods: This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). Results: Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were $80.0%{\pm}7.3%$ and $60.8%{\pm}10.1%$, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were $92.3%{\pm}5.2%$, $68.9%{\pm}10.2%$, and $50.3%{\pm}13.6%$, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were $91.7%{\pm}8.0%$, $41.7%{\pm}14.2%$, and $25.0%{\pm}12.5%$, respectively. Conclusion: Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.296-306
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• 1992

A 6 year experience with the bileaflet St. Jude Medical valve is reported. Between Feb. 1986 and Dec. 1992, 68 patients received 87 such valves[36 mitral, 13 aortic, and 19 double mitral-aortic valve replacements]. The results are summarized as follows 1. There were 35 male and 33 female patients ranging in age from 17 to 55 years the mean age of 35.3 $\pm$ 9.7 years. 2. The mean aortic clamp time[ACT] of the MVR, AVR and DVR groups were 91.5$\pm$16.4, 117.2$\pm$28.7 and 165.5$\pm$24.1 minutes. The mean total bypass time [TBT] of the MVR, AVR and DVR groups were 112.8$\pm$19.5, 134.7$\pm$31.4 and 192.2$\pm$28.5 minutes. 3. Eighty seven valves were used [55 mitral site, 32 aortic site]. 31mm[20], 33mm[15], 29mm[15], 27mm[2], 25mm[2] and 35mm[1] were used in mitral site and 23mm[13], 21mm[8], 19mm[7] and 25mm[4] were used in the aortic site. In the DVR, there were valve combinations such as 4 cases of M[29mm]-A[19mm], 4 of M[31mm]-A[23mm], 3 of M[33mm]-A[23mm] and others. 4. Preoperative NYHA functional classes were II [3 cases], III [46 cases], IV[19 cases] and improved to I [52 cases] and Il [13 cases] postoperatively. 5 Early postoperative complications were occurred in 15 cases[2Z.l%] and there were LOS in 5 cases[7.4%], arrythmia [3 cases], wound infection [2 cases], hepatitis [2 cases], sudden cardiac arrest [2 cases] and postoperative bleeding [1 case]. The early hospital death was occurred in 3 cases[4.4%] with LOS [1 case] and sudden cardiac arrest [2 cases]. 6. Mean follow-up time of survival cases[65 cases] was 31.3$\pm$21.9 months and the total follow-up time was 169.8 patient-years. Late postoperative complications were occurred in 4 cases[2 thromboembolism, 1 paravalvular leak, 1 thromboembolism br paravalvular leak, 1 valve endocarditis] with the occurrence rate as 2.35% per patient-years. Reoperation was performed in 2 cases [1 paravalvular leak, 1 left atrial thrombus] and there was one [1.5%] late valve related death. Therefore the 6 year complication free rate was 90.6% and 6 year actuarial survival rate was 98.3$\pm$1.7%. On the basis of this experience and the results, SJMvalve appears to be one of the best performing mechanical prosthesis currently available, in terms of both hemodynamics and lower complications with warfarin antioagulation.