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12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Repeated thromboembolic and bleeding events after mechanical aortic valve replacement
F P Casselman1, M L Bots, W Van Lommel
1Department of Cardiovascular Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands. casself@hotmail.com
The Annals of Thoracic Surgery
|April 20, 2001
Summary
Mechanical aortic valve replacement (AVR) carries substantial long-term risks of thromboembolic (TE) and bleeding (BLE) complications, particularly within the first five years post-surgery. Patients experiencing an initial event face an increased risk of subsequent complications.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Risk Management
Background:
- Mechanical aortic valve replacement (AVR) necessitates balancing long-term anticoagulation risks against reoperation needs in young adults.
- Understanding long-term thromboembolic (TE) and bleeding (BLE) complications is crucial for informed valve substitute selection.
Purpose of the Study:
- To analyze the long-term risks and determinants of TE and BLE complications following mechanical AVR.
- To provide data informing the choice of valve substitute in younger patient populations.
Main Methods:
- Analysis of 249 patients who underwent mechanical AVR between 1963 and 1974, with a mean follow-up of 19.5 years (4,855 patient-years).
- Utilized Kaplan-Meier and multivariable Cox regression for event analysis.
- Compared outcomes between ball and disc valve types.
Main Results:
- Freedom from a first TE or BLE event was 46.8% at 30 years; freedom from a second event was 23.2% at 30 years.
- Ball valve type (OR=2.9), postoperative endocarditis (OR=2.2), and any surgery (OR=2.2) were significant predictors of TE/BLE complications.
- The highest incidence of complications occurred within the first five postoperative years.
Conclusions:
- Adverse events, including TE and BLE complications, are most frequent in the initial five years after mechanical AVR.
- A prior event significantly increases the risk of subsequent complications.
- The substantial incidence and frequency of these events must be factored into the decision-making process for aortic valve prostheses.
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