Bileaflet mechanical valve replacement: an assessment of outcomes with 30 years of follow-up

Abstract

Low late mortality and a low incidence of valve-related events can be achieved for at least 30 years using mechanical bileaflet valve replacement. Persistent atrial fibrillation is a significant risk factor for morbidity and mortality.

Sex‐based difference in anticoagulated patients with mechanical prosthetic heart valves and long‐term mortality risk

“…4 During 34-year follow-up, the mortality rate was 0.59%/year for cardiac death and 0.69%/year for valverelated death. 4 At multivariable analysis, the Authors found that male sex was associated with an increased risk of death (HR 1.25, 95%CI 1.11-1.42, P = .0003), but the analysis was not apparently adjusted for comorbidities and antithrombotic treatments, including anticoagulation quality. 4 We found low anticoagulation quality, high INR range, ageing and comorbidities as the most important factors associated with mortality, both in the aortic and mitral MPHV group.…”

“…4 At multivariable analysis, the Authors found that male sex was associated with an increased risk of death (HR 1.25, 95%CI 1.11-1.42, P = .0003), but the analysis was not apparently adjusted for comorbidities and antithrombotic treatments, including anticoagulation quality. 4 We found low anticoagulation quality, high INR range, ageing and comorbidities as the most important factors associated with mortality, both in the aortic and mitral MPHV group. Our finding that low TiTR < 60% is associated with an increased mortality risk supports and extends previous evidence that high variability of INR was associated with poor survival in patients undergoing single valve replacement (HR 1.8 per 20% increase).…”

“…MPHV having less thrombogenicity. 4 Furthermore, no data on antithrombotic treatments, in particular on oral anticoagulation, were reported in those studies. This last point is particularly important as MPHV patients require long-term oral anticoagulation therapy with vitamin K antagonists (VKAs) to reduce the risk of valve thrombosis, thromboembolism, and mortality.…”

Optimal Intensity of Warfarin Therapy in Patients With Mechanical Aortic Valves

“…The open-label, single-center randomized controlled noninferiority trial 19 In a 30-year retrospective cohort analysis of 950 AVR at a single center in Japan, 88.6%, 89.8%, and 94.4% of AVR patients were free from valve-related mortality, thromboembolic events, and bleeding events, respectively, after 30 years when anticoagulated to a target INR of 1.6 to 2.5. 20 Atrial fibrillation independently predicted increased risk of TE and age older than 70 years, and previous operation independently predicted anticoagulation-related hemorrhage. Although this study helps to justify lower INR goals, it is important to note that lower target INR goals have been proposed in Japan due to a higher risk of warfarin-related intracranial hemorrhage and these same goals may not be appropriate in Caucasian populations.…”

Minimally Invasive Video-assisted Mitral Valve Replacement with a Right Chest Small Incision in Patients Aged Over 65 Years

“…Traditional open-chest surgery has the advantage of good exposure of the surgical field, which can markedly shorten cardiac arrest and cardiopulmonary bypass (CPB) times, but also has disadvantages of large surgical wounds, more bleeding, severe pain, and slow postoperative recovery [7,8] . Total thoracoscopic and thoracoscopic-assisted cardiac surgery have emerged in recent years [9-11] .…”