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J Thorac Cardiovasc Surg 1998;116:1005-1014
© 1998 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

THE MEDTRONIC INTACT* PORCINE VALVE: TEN-YEAR CLINICAL REVIEW

*Medtronic, Inc, Minneapolis, Minn.

Received for publication May 6, 1998. Revisions requested July 1, 1998; revisions received July 29, 1998. Accepted for publication Aug 6, 1998. Address for reprints: Sir Brian Barratt-Boyes, PO Box 51, Waiwera, Auckland 1240, New Zealand.

Objective: Our objective was to assess the long-term mortality and morbidity associated with the Medtronic Intact valve (Medtronic, Inc, Minneapolis, Minn).
Method: Between 1983 and 1996, 447 patients (280 men and 167 women) received 466 Intact valves: 280 aortic, 156 mitral, and 30 tricuspid. The mean age was 57 years (median 63 years), with 45% younger than 60 years. The mean New York Heart Association class was 3.1. The follow-up was 98% complete and extended for 39 months (1-154 months) and 1324 patient-years. There were 32 valves at risk at 10 years after implantation. Doppler echocardiography was performed whenever possible in patients followed up for longer than 4 years (mean 8 years) after implantation.
Results: Ten-year overall actuarial survival was 30% ± 6% (14% ± 7% for New York Heart Association classes IV-V and 39% ± 8% for classes I-III). At 10 years freedom from infective endocarditis was 92% ± 3%, freedom from thromboembolism was 80% ± 5%, and freedom from nonstructural valve deterioration was 95% ± 2%. Ten-year freedom from explantation was 64% ± 6%, freedom from valve-related events was 51% ± 6%, and freedom from valve-related death was 88% ± 3%. There were 26 examples of structural valve deterioration, mainly caused by leaflet calcification (in 17 cases) and by buttress detachment (in 6 cases). In the aortic position at 10 years freedom from structural valve deterioration was 81% ± 9%, but with only 1 event in patients older than 40 years (freedom 92% ± 8%) and 100% freedom in patients older than 60 years. There was also 100% freedom from structural valve deterioration in the tricuspid position. In the mitral position freedom was 65% ± 8%, with no significant difference between age groups.
Conclusion: The Intact valve provides superior results in the aortic position in patients older than 40 years and in the tricuspid position at all ages.

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