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Thromboembolic complications with the cloth-covered Starr-Edwards aortic prosthesis in patients not receiving
Insights
Permanent anticoagulation is recommended for patients receiving Starr-Edwards prostheses after aortic valve replacement. Discontinuing anticoagulation increases the risk of thromboembolic (TE) episodes, including fatal major emboli.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Cloth-covered Starr-Edwards prostheses are used in aortic valve replacement.
- Thromboembolic (TE) events are a significant complication following prosthetic valve implantation.
Purpose of the Study:
- To compare the incidence of TE episodes in patients with cloth-covered Starr-Edwards prostheses based on anticoagulant therapy.
- To determine the optimal duration of anticoagulation for patients with these prostheses.
Main Methods:
- Retrospective comparison of three patient groups undergoing aortic valve replacement with cloth-covered Starr-Edwards prostheses.
- Group 1: Patients on anticoagulants (permanent or variable duration).
- Group 2: Patients never receiving anticoagulants.
- Group 3: Patients who stopped anticoagulants after initial treatment.
Main Results:
- Group 1 (147 patients): 14 TE episodes (6 major, 3 fatal).
- Group 2 (82 patients): 20 TE complications (10 major).
- Group 3 (22 patients): 5 TE episodes (all major).
Conclusions:
- Permanent anticoagulation is advised for all patients with cloth-covered Starr-Edwards prostheses.
- The risk of TE episodes remains significant, even after variable periods without anticoagulation.
Abstract:
A comparison of the incidence of thromboembolic (TE) episodes was made in three groups of patient who underwent aortic valve replacement with the cloth-covered Starr-Edwards prostheses. Group 1 consisted of patients who received anticoagulants for either the entire period of follow-up or for a period of variable duration, after which these agents were no longer administered. When anticoagulants were stopped, 22 patients were categorized as Group 3 for study. Group 2 comprised patients who never received anticoagulants. Of the 147 patients followed in Group 1, 14 suffered one episode of TE. Six patients experienced major emboli; 3 of them died. Twenty of the 82 patients followed in Group 2 (no anticoagulants) suffered TE complications. There were 10 episodes of major emboli. Five of the 22 patients in Group 3 suffered an episode (all major) of TE. It is concluded from this study that anticoagulants should be given permanently to all patients with cloth-covered Starr-Edwards prostheses. Indeed, there is no period after operation when the incidence of TE is so low that anticoagulation may be safely discontinued.