Document Detail

Twenty years' single-center experience with mechanical heart valves: a critical review of anticoagulation policy.
MedLine Citation:
PMID:  22474748     Owner:  NLM     Status:  In-Process    
BACKGROUND AND AIM OF THE STUDY: Since January 1990, a variety of mechanical valves (St. Jude Medical, CarboMedics, ATS Medical) have been implanted routinely at the authors' institution. The study aim was to analyze, retrospectively, the 20-year clinical results of those mechanical valves, and to challenge the anticoagulation policy employed over the years.
METHODS: Between January 1990 and December 2008, a total of 2,108 mechanical valves was inserted into 1,887 consecutive patients (1,346 aortic, 725 mitral, 27 tricuspid, 10 pulmonary). The mean age of the patients was 63 +/- 13.2 years, and the majority (61%) were males. Preoperatively, 71% the patients were in NYHA class > or = III (average 3.01). The most frequent comorbidities included: atrial fibrillation (n = 594), coronary disease (n = 567) and diabetes (n = 398). The follow up (99% complete) totaled 13,721 patient-years (pt-yr), and ranged from 12 to 241 months (average 84 months).
RESULTS: In-hospital mortality was 5.2% (n = 98, 14 valve-related). Of the 629 late deaths, the majority were cardiac (n = 276). Survival (Kaplan-Meier estimation) was significantly better for aortic valve patients compared to mitral or multiple valve replacement (Mantel-Cox, p < 0.0001). The overall linearized incidences (as %/pt-yr) were: valve thrombosis 0.31, thromboembolism 1.08, and bleeding 0.91. However, as repeated events occurred in several patients, the hazard function was not constant. Multivariate analysis (Cox regression model) showed age > 70 years (p < 0.0001), NYHA class > or = III (p < 0.0001), non-sinus rhythm (p = 0.001), concomitant coronary artery bypass grafting (p = 0.008) and higher International Normalized Ratio (INR) values (p = 0.013) as significant risk factors for death, with a trend for redo operations (p = 0.052). Multivariate analysis found variable INR, non-sinus rhythm and NYHA class > II as significant risk factors for thromboembolism, while long-acting coumadin and NYHA class > II were significant risk factors for bleeding.
CONCLUSION: This 20-year experience demonstrated excellent clinical outcomes for patients with mechanical prostheses, with no valve structural failure and an acceptable incidence of adverse events. INR values between 2-2.5 for aortic valve patients, and 3-3.5 for mitral valve patients, yielded the fewest major adverse events.
Guido J Van Nooten; Frank Caes; Katrien François; Yves Van Bellleghem; Thierry Bové; Guy Vandenplas; Yves Taeymans
Related Documents :
11512528 - A comparative study of clarithromycin modified release and amoxicillin/clavulanic acid ...
23294238 - Long-term voice results of injection with hyaluronic acid-dextranomere in unilateral vo...
12501878 - Cefditoren pivoxil versus cefpodoxime proxetil for community-acquired pneumonia: result...
24885248 - Transcultural adaptation and validation of the "hip and knee" questionnaire into spanish.
19050408 - The long-term effect of tetrabenazine in the management of huntington disease.
10219868 - Repeated use of computerized case simulations in a test format does not present a secur...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  21     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-04-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  88-98     Citation Subset:  IM    
Cardiac Surgery Department, 5K12 University Hospital Ghent, De Pintelaan, 185, 9000 Ghent, Belgium.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Patterns of anticoagulation following bioprosthetic valve implantation: observations from ANSWER.
Next Document:  Diastolic properties of the Sorin Solo, ATS 3F, Edwards Prima Plus and Medtronic Freestyle stentless...