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[Thromboembolism with the Ionescu-Shiley bovine pericardial bioprosthesis. Long-term results (11 years)]
J R González-Juanatey1, J Rubio Alvarez, J Sierra Quiroga
1Servicio de Cirugía Cardíaca, Hospital General de Galicia, Santiago de Compostela.
Insights
The Ionescu-Shiley pericardial bioprosthesis shows low thrombogenicity, even without long-term anticoagulation. Early anticoagulation did not impact thromboembolic events, suggesting it may not be necessary for these bioprosthetic valves.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Thrombosis Research
Context:
- Assessing the thrombogenicity of treated bovine pericardial tissue is crucial for bioprosthetic heart valve safety.
- The Ionescu-Shiley pericardial bioprosthesis is a widely used device in cardiac valve replacement surgery.
- Patient populations often present with significant risk factors for thromboembolic events, including atrial fibrillation and advanced functional class.
Purpose:
- To evaluate the incidence of thromboembolism in patients receiving Ionescu-Shiley pericardial bioprostheses.
- To determine the impact of early anticoagulation on thromboembolic events in recipients of these bioprosthetic valves.
- To assess the long-term thrombogenicity of the Ionescu-Shiley pericardial bioprosthesis.
Summary:
- A study of 376 Ionescu-Shiley pericardial bioprostheses in 349 patients over 11 years found a low incidence of thromboembolism (3.72% overall, 0.84% per patient/annum).
- Early anticoagulation (8-12 weeks) was administered to 232 patients; however, it did not influence the rate of thromboembolic events compared to those without anticoagulation.
- No valve thrombosis was observed. Central thromboembolic events occurred in 10 patients, with significant morbidity, while peripheral events were less common.
Impact:
- The Ionescu-Shiley pericardial bioprosthesis demonstrates favorable long-term thrombogenicity, potentially reducing the need for chronic anticoagulation.
- Findings suggest that early anticoagulation may not be justified for patients with Ionescu-Shiley pericardial bioprostheses, even in the presence of risk factors.
- This research informs clinical decision-making regarding anticoagulation strategies for patients with pericardial bioprosthetic valves.
Abstract:
With the aim to asses the thrombogenicity of "treated" bovine pericardial tissue, the incidence of thromboembolism with Ionescu-Shiley pericardial bioprostheses was analyzed in 349 operative survivors since January 1977. A total of 376 valves were available for the study. Mean age was 59 years. Preoperatively atrial fibrillation was present in 68.2% (91.7% of the mitral replacement group) and 62% were in NYHA functional class III-IV; in 10.6% previous embolism had been documented. Early anticoagulation (8-12 weeks) was administered in the first 232 patients (113 mitral replacements, 98 aortic replacements and 21 multiple replacements) and the rest of the patient population had no anticoagulation at all. Thromboembolic events were documented in 13 patients (3.72%) or 0.84% per patient/annum (1.49% per patient/annum for mitral and multiple replacements and 0.13% per patient/annum for aortic replacements). Early thromboembolism was detected in 6 patients (3 months after surgery), all in anticoagulated patients, three being in sinus rhythm. No valve thrombosis was detected in this series. Three patients with late thromboembolism were in NYHA functional class III-IV. Ten thromboembolic events were central (1 died and three had permanent neuro-residua). In two the location was peripheral and another one in the kidney. The Ionescu-Shiley pericardial bioprosthesis after 11 years has demonstrated a low thrombogenicity in the absence of chronic anticoagulation. Early anticoagulation does not influence the rate of thromboembolism during this period and therefore we believe that this therapeutic approach is not justified despite the presence of risk factors.