An appreciation of the new St. Jude valvular prosthesis.

Beginning in March, 1978, 88 patients have had cardiac valve replacements with St. Jude prostheses. There were 26 males and 62 females, aged 6 to 80 years (mean 60). Single valve replacement was done in 67. Double valve replacement was done in 21; 12 of them had two St. Jude valves and nine had a different second valve. There were 57 mitral and 43 aortic valves replaced. Thirty-six patients had concomitant aorta-coronary bypass, and six others had additional cardiac procedures. All patients have been followed for a total of 807 patient-months (mean 9 months). Seventy-nine have been receiving sodium warfarin and seven are not receiving anticoagulants. There has been one embolic episode. There are no valve failures to date. Early mortality is 2.3% and late mortality, 5.7%; no death was valve related. Fifty-three survivors have improved by two or more N.Y.H.A. classifications. Fifty-four valves studied postoperatively at rest, during pacing, and during isoproterenol infusion have demonstrated significantly better hemodynamic performance than have mitral porcine xenografts studied in an identical manner (p < 0.05). Phonocardiography, M-mode and two-dimensional echocardiography, and cinefluoroscopy, carried out in 18 patients, have proved to be reliable noninvasive techniques for long-term follow-up. This experience indicates that the St. Jude prosthesis offers an excellent and predictable alternative in the surgeon's decision-making concerning valve choices.