CARDIAC VALVE REPLACEMENT : CURRENT STAT

Cardiac Valve Replacement: Current Status is the proceedings of the Fourth Interna­ tional Symposium on the ST. JUDE MEDICAL@ valve. The first three symposia on this topic were held primarily for designated investigators involved in clinical trials of the ST. JUDE MEDICAL valve. The last meeting, chaired by Michael E. DeBakey, M.D., was held in November 1982 [1], immediately before the valve was released for general clinical use in the United States by the Food and Drug Administration. These proceedings then are the first comprehensive compilation of clinical data since that time; and they include, particularly in the discussions, the experience of physicians other than the original clinical investigators. Over the past 5 years the character of these symposia has changed. Whereas the first two dealt almost entirely with the ST. JUDE MEDICAL valve, the last two have evolved into a more generic cardiac valvular surgery meeting, focusing primarily on valve replacement rather than valve repair [2]. Thus, these proceed­ ings contain a wide spectrum of topics, including a keynote presentation on criteria for selection of cardiac valve substitutes in 1984, complications of cardiac valve replacement and their treatment, a review of the current status of cardiac valve substitutes other than the ST. JUDE MEDICAL valve and a consideration of cardiac valve replacement in special circumstances. Among these special circum­ stances are four presentations on pediatric use of the ST. JUDE MEDICAL valve.

I Complications of Cardiac Valve Replacements and Their Treatment.- 1. Following the patient with prosthetic heart valves.- 2. Thromboembolism after cardiac valve replacement.- 3. Nonprosthetic factors producing thromboembolism in patients with cardiac valve substitutes: their nature and the problems of assessing their role.- 4. Anticoagulant therapy and cardiac valvular surgery: Coumadin® and other alternatives.- 5. Reoperation after cardiac valve surgery: elective, urgent and emergent.- Discussion.- II Cardiac Valve Substitutes: Current Status.- 6. Clinical experience with the caged-ball Starr-Edwards® prosthesis.- 7. Overview of experience with the Björk-Shiley® valve.- 8. Experience with standard and supra-annular Carpentier-Edwards® porcine bioprostheses.- 9. Aortic valve replacement with the Ionescu-Shiley® bovine pericardial valve: an 81-month experience.- Discussion.- III Cardiac Valve Replacement in Special Circumstances.- 10. Annuloaortic ectasia: surgical repair using a composite St. Jude Medical® valve and Dacron® tube graft.- 11. Valve replacement in the geriatric patient using the St. Jude Medical® prosthesis.- 12. Tricuspid valve replacement―a comparative experience with different valve substitutes.- 13. Double valve replacement.- 14. Cardiac valve replacement in the presence of coronary atherosclerosis.- Discussion.- IV Cardiac Valve Replacement in Pediatric Practice: Experience with the St. Jude Medical® Valve.- 15. St. Jude Medical® valve replacement in infants and children.- 16. Pediatric use of the St. Jude Medical® prosthesis.- 17. Mitral valve replacement in a child using the St. Jude Medical® valve.- 18. Thromboembolism in children with St. Jude Medical® valves maintained on aspirin and Persantine®.- Discussion.- V Intermediate Follow-up of Patients with St. Jude Medical® Prostheses: 52 to 72 Months.- 19. A 52-month experience with the St. Jude Medical® cardiac prosthesis at the Medical University of South Carolina.- 20. A 57-month experience with the St. Jude Medical® cardiac prosthesis at Hahnemann University Hospital.- 21. Incidence of complication with the St. Jude Medical® prosthesis: a 58-month study at Hamot Medical Center.- 22. Mitral valve replacement with St. Jude Medical® prostheses: a 60-month study of 350 cases at Centre Hospitalier Universitaire.- 23. A 60-month experience with the St. Jude Medical® prosthesis at Cedars-Sinai Medical Center.- 24. A 60-month experience with the St. Jude Medical® prosthesis at University Hospital, Brugmann.- 25. A 72-month clinical experience with the St. Jude Medical® cardiac valve prosthesis at Newark Beth Israel Medical Center.- 26. A 72-month experience with the St. Jude Medical® cardiac valve prosthesis at the Minneapolis Heart Institute and United Hospitals, St. Paul, Minnesota.- 27. A 72-month clinical experience with the St. Jude Medical® prosthesis at Tucson Medical Center.- Discussion.- VI Clinical Experience with Current Cardiac Valve Substitutes: Comparative Observations.- 28. Late complications in patients with Björk-Shiley® and St. Jude Medical® prostheses.- 29. Experience with the St. Jude Medical® valve and the Ionescu-Shiley® bovine pericardial valve at the Texas Heart Institute.- 30. Comparative assessment of single Björk-Shiley®, Hancock® and St. Jude Medical® valves at 43 months after operation.- Discussion.- VII Clinical Forum.- 31. Noninvasive assessment of prosthetic heart valve function by continuous-wave doppler ultrasound.- 32. Potential for immobilization of the valve occluder in various valve prostheses.- 33. Escape of a leaflet from a St. Jude Medical® prosthesis in the mitral position.- 34. Prophylaxis against thromboembolism using aspirin and dipyridamole in patients with the St. Jude Medical® aortic prosthesis.- Discussion.- VIII Closing Observations.- 35. Summary and concluding remarks.- 36. Summary and concluding observations.