OBJECTIVES: In heart valve replacement, long-term stability is the most important consideration in selecting prosthetic valve, and prevention of valve related complication is also thought to be important. To identify the stability and the effect of intensive management with regular follow up to reduce valve related complications, we reviewed 20 year experiences in patients with St. Jude Medical(SJ) prosthetic valve. METHODS: Between 1984 and 2003, we did 1001 cases of valve replacement using SJ valve in 980 patients (427 men, 574 women). The mean age was 43.5 years. Causes of diseases were rheumatic (656), prosthetic valve failure (120), bicuspid aortic valve (68), infective endocarditis (44) and others (113). The operations included AVR (216), MVR (532), DVR (AVR+MVR) (204) and valve replacement including tricuspid (49). Mean follow up was 9.8(0.1~20.5) years and follow up rate was 96.6%. RESULTS: There were 30 in hospital deaths (3.0%) and 140 (14.4%) late deaths. There were 150 postoperative valve related events, including 36 thromboembolism and 28 bleeding episodes. Kaplan-Meier survival at 20 years was 68.6%. At 20 years, 94.4% of patients were free of thromboembolism and 95.4% of patients were free of anticoagulation related bleeding. Linearized incidences of thromboembolism, valve thrombosis(VT), anticoagulation related hemorrhage (bleeding), valve related event(event), valve related death(death) between before and after intensive valve follow up are shown at the table below. (unit: %/patient-year) CONCLUSIONS: Long-term results of SJ valve were excellent. Intensive management could reduce the incidence of cerebral thromboembolism, valve thrombosis and valve related events.