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Mitral valve Carpentier-Edwards bioprosthetic replacement, thromboembolism, and anticoagulants
Y A Louagie1, J Jamart, P Eucher
1Division of Cardiovascular and Thoracic Surgery, University Hospital of Mont Godinne (Yvoir), Belgium.
Insights
Patients receiving bioprosthetic mitral valve replacement (MVR) often need long-term anticoagulation. Supraventricular arrhythmia and prior thromboembolism predict this need, suggesting mechanical valves for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Replacement
- Thromboembolism Prevention
Background:
- Bioprosthetic mitral valve replacement (MVR) often necessitates long-term anticoagulation, negating a key benefit.
- Identifying predictors for long-term anticoagulation is crucial for optimizing patient management post-MVR.
Purpose of the Study:
- To identify predictive factors for the need for long-term anticoagulant treatment after bioprosthetic MVR.
- To improve patient selection for valve type based on individual risk profiles.
Main Methods:
- Retrospective follow-up of 100 patients surviving bioprosthetic MVR between 1977 and 1987.
- Statistical analysis including Cox regression and Fisher linear discriminant analysis to assess risk factors.
Main Results:
- Thromboembolism-free survival was 88.9% at 6 years.
- Preoperative risk factors for thromboembolism included supraventricular arrhythmia and history of thromboembolism.
- Postoperative rhythm was the only significant factor influencing thromboembolism-free survival.
- Supraventricular arrhythmia, septal myotomy, and predominant mitral stenosis predicted the need for long-term anticoagulation.
Conclusions:
- Patients with predominant mitral stenosis and preoperative supraventricular arrhythmia have a high likelihood of requiring permanent anticoagulation post-MVR.
- Mechanical valve implantation is recommended for these high-risk patients, barring contraindications to anticoagulation.
Abstract:
Patients undergoing mitral valve replacement (MVR) using a bioprosthesis are frequently placed on long-term anticoagulant treatment, and thereby lose the main advantage conferred by the bioprosthesis. To assess predictive factors of the need for long-term anticoagulant treatment, 100 consecutive patients surviving bioprosthetic MVR between 1977 and 1987 were followed up. The estimated thromboembolism-free survival was 88.9% +/- 3.6% after 6 years of follow-up. Preoperative risk factors for thromboembolism were supraventricular arrhythmia (p = 0.013) and a history of thromboembolism (p = 0.039). Among the preoperative and postoperative factors, only postoperative rhythm significantly influenced (p = 0.007) the thromboembolism-free survival, as determined by Cox regression analysis. Permanent anticoagulant treatment was instituted in 39 patients. Preoperative and peroperative risk factors associated with the need for long-term anticoagulant treatment, as evidenced by Fisher linear discriminant analysis, were supraventricular arrhythmia (p < 0.001), septal myotomy (p = 0.013), and predominant mitral stenosis (p = 0.013). Thus, in those patients with predominant mitral stenosis and supraventricular arrhythmia preoperatively, the subsequent need for permanent postoperative anticoagulant treatment is high, and the implantation of a mechanical valve is therefore recommended, providing there are no strict contraindications to anticoagulant treatment.