Incidence of embolism and paravalvar leak after St Jude Silzone valve implantation: experience from the Cardiff Embolic Risk Factor Study
- 1Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
- 2Department of Cardiology, University Hospital of Wales
- 3Department of Haematology, University Hospital of Wales
- 4Medical Data Research Center, Providence Health System, Portland Oregon USA
- Correspondence to:
Mr Eric G Butchart, Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK;
- Accepted 10 April 2003
Background: Silver coating of the sewing ring (Silzone) was introduced as a modification of the St Jude Medical standard valve to provide antibacterial protection, but the valve has recently been withdrawn.
Objective: To study patients with these prostheses to assess possible adverse effects, and to guide their follow up.
Design: Prospective observational study of risk factors for stroke after valve replacement.
Setting: Cardiology and cardiac surgery departments in a tertiary centre.
Patients: There were 51 patients with Silzone and 116 with St Jude Medical standard valves. Patients undergoing aortic valve replacement were well matched for stroke risk factors. Silzone patients with mitral valve replacement were younger (mean (SD) age 61 (10) v 66 (7) years), more likely to be female (95% v 65%), and had more pulmonary arterial hypertension (100% v 78%), but fewer coronary artery bypass grafts (5% v 33%) than patients with standard mitral valve replacements (all p < 0.05).
Results: Follow up was 100% in the Silzone group (mean duration 3.0 (0.9) years) and 97.4% in the standard group (4.7 (1.4) years). Survival, morbidity, and anticoagulant control were documented over 682 follow up years (153 for Silzone and 529 for standard). There were six embolic strokes and one peripheral embolism in the Silzone group, all within three months after operation, and five embolic strokes and one peripheral embolism in the standard group. Freedom from major thromboembolism at three months was 65% in the Silzone mitral valve replacement group and 100% in the standard mitral valve replacement group (difference 35%, 95% confidence interval 8% to 62%). There was one reoperation for paravalvar leak in the standard group, but none in the Silzone group (NS). Anticoagulant control in the two groups was similar.
Conclusions: Patients with Silzone mitral valves had a high rate of early postoperative embolism but no excess paravalvar leak.
- AVERT, artificial valve endocarditis reduction trial
- CERFS, Cardiff embolic risk factor study
- INR, international normalised ratio
- NYHA, New York Heart Association
- TIA, transient ischaemic attack