Estudo comparativo entre válvulas biológicas e válvulas mecânicas nas posições mitral ou aórtica até 14 anos

Braile, Domingo Marcolino; Ardito, Roberto Vito; Zaiantchick, Marcos; Santos, José Luiz Verde dos; Campos, Nelson Leonardo Kerdahi Leite de; Jacob, José Luiz Balthazar; Souza, Dorotéia Rossi Silva; Rade, Walter; Martins, Maria Inês; Lorga, Adalberto Menezes

doi:10.1590/s0102-76381988000300001

Cited by 3 publications

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References 5 publications

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“…In Brazil, studies were conducted to evaluate complications in patients with mechanical heart valve prostheses [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

Campos¹,

Andrade²,

Silva³

2010

Rev Bras Cir Cardiovasc

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Background: Published data suggest that rates of thromboembolism and bleeding in patients with mechanical heart valve prostheses can be greatly reduced if anticoagulant therapy is optimized.Objectives: To evaluate the occurrence of complications in patients with mechanical prosthetic heart valves undergoing anticoagulant therapy optimized by means of specialized clinics.Methods: We studied the occurrence of complications during 10 years in 261 patients with mechanical heart valve prostheses with anticoagulation and followed up in specialized clinics. These patients were divided into two groups according to percentage of consultations with prothrombin time (INR) within the desired range: G1-0% to 50.00% and G2-50, 01% to 100% of the consultations. We evaluated the occurrence of thromboembolic complications and bleeding in their entirety or subdivided into major and minor, according to severity. The results are presented in an actuarial study and linearized frequency of occurrence of events.Results: The actuarial study showed that, over time, in G2 (with 50.01% to 100% of the consultations with INR in desired range) more patients were free of the occurrence of any event type, minor bleeding events or the accentuated increase of INR. The linearized frequency of occurrence in all event types was also lower in group G2.Conclusions: The length of stay within the desired range of anticoagulation is directly related to the occurrence of complications. However, even with optimized monitoring by specialized outpatient clinic, only about a third of patients had adequate anticoagulation level in more than half of the consultations.Keywords: Anticoagulants. Embolism and thrombosis. Hemorrhage. Heart valve prosthesis. 458CAMPOS, NLKL ET AL -Oral anticoagulation in carriers of mechanical heart valve prostheses. Experience of ten years Rev Bras Cir Cardiovasc 2010; 25(4): 457-465Resumo Introdução: Dados da literatura sugerem que as taxas de tromboembolismo e sangramento em pacientes com próteses valvares cardíacas mecânicas podem ser muito reduzidas se a terapia anticoagulante for otimizada.Objetivos: Avaliar a ocorrência de complicações em portadores de próteses valvares cardíacas mecânicas submetidos à terapêutica anticoagulante, otimizada por meio de ambulatório especializado.Métodos: Estudou-se a ocorrência de complicações ao longo de 10 anos em 261 pacientes com próteses valvares cardíacas mecânicas, anticoagulados e acompanhados em ambulatório especializado. Esses pacientes foram divididos em dois grupos conforme porcentual de consultas com tempo de protrombina (RNI) dentro do intervalo desejado: G1-0% a 50,00% e G2-50,01% a 100% das consultas. Foram avaliadas as ocorrências de complicações tromboembólicas e hemorrágicas na sua totalidade, ou subdivididas em maiores e menores, de acordo com a gravidade. Os resultados estão apresentados sob forma de estudo atuarial e de frequência linearizada de ocorrência de eventos.Resultados: O estudo atuarial mostrou que, ao longo do tempo, no grupo G2 (com 50,01% a 100% das co...

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“…In Brazil, studies were conducted to evaluate complications in patients with mechanical heart valve prostheses [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

Campos¹,

Andrade²,

Silva³

2010

Rev Bras Cir Cardiovasc

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“…In the study with mono-leaflet prostheses (Meditronic Hall) Butchart et al [ 9 ] the percentage of patients free of major bleeding events after 10 years was 87% in the mitral position.…”

Section: Resultsmentioning

confidence: 99%

“…Braile et al [ 9 ] , in Brazil, studied complications in 126 mitral mono-leaflet mechanical prostheses of some types (Björk-Shiley 49, 71 Liliehei-Kaster, 6 Hall-Kaster), with all patients receiving oral anticoagulants. The incidence of thrombosis and thromboembolism was 7.7 per 100 patient-years for patients with Björk-Shiley, 5.6 and 6.7 per 100 patient-years for those with Liliehei-Kaster and Hall-Kaster prostheses, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have assessed the occurrence of thromboembolic and bleeding complications in patients with mechanical mono-leaflet heart valve prostheses [ 6 - 9 ] and double bi-leaflet [ 10 , 11 ] , however, without comparing the two types of prosthesis. Then, we perform a particular study comparing patients with mono- and bi-leaflet prosthesis in the mitral position, given that patients have no cage-ball in this position.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

Campos¹

2014

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionPatients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation.ObjectiveTo compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy.MethodsWe studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events.ResultsThe actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve.ConclusionPatients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature.

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IMC Bovine Pericardial Valve: 11 Years

Braile¹,

Ardito²,

Greco³

et al. 1991

Journal of Cardiac Surgery

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From 1977 to 1988, 10,812 bovine pericardial valves were produced by IMC Biomédica and implanted. One thousand one hundred ninety‐three were implanted by our group at IMC, including 666 exclusively in the mitral position. We are presenting our study of those mitral patients. Of the 663 patients, 586 were adults (over 21 years of age) and 77 were youngsters (under 21). Hospital mortality was 9.2%; 13.2% for the first 5.5 years (group I) and 6.3% for the second 5.5 years (group II). Eleven year follow‐up was 98.8% complete and the mean time was 3.8 years. The actuarial survival was 74.3% ± 6.5% for the youngsters and 73.0% ± 3.7% for the adults. The fatal valve‐related late complications (death from thromboembolism, calcification, and endocarditis) had an incidence of 1% per patient‐year as follows: (1) endocarditis, 0.6% per patient‐year; (2) calcification 0.1% per patient‐year; and (3) cerebral vascular accident, 0.3% per patient year. The actuarial study revealed 95.0 % ± 1.0% freedom from fatal complications related to the prosthesis. The nonfatal valve‐related late complications had an incidence of 2.9% per patient‐year as follows: (1) endocarditis, 0.5% per patient‐year; (2) calcification, 1.8% per patient‐year; (3) cerebral vascular accident, 0.3% per patient‐year; (4) periprosthetic leakage, 0.2% per patient‐year; and (5) rupture, 0.1% per patient‐year. The actuarial study revealed 55.2% ± 8.6% freedom from all complications including thromboembolism, endocarditis, calcification, periprosthetic leakage, and rupture. The actuarial study of the bioprosthesis revealed 95.8% ± 1.6% freedom from thromboembolism (linearized rate of 0.6% per patient‐year); 99.1 % ± 0.6% freedom from rupture (linearized rate of 0.08% per patient‐year); 90.1% ± 4.08% freedom from endocarditis in the young group (linearized rate of 1.5% per patient‐year); and 95.2% ± 1.03% for adults (linearized rate of 1.0% per patient‐year). Freedom from calcification was 43.1% ± 12.25% for the young group (linearized rate of 7.5% per patient‐year) and 68.8% ± 9.3% for adults (linearized rate of 1.1% per patient‐year) in the 11th year. We conclude that the IMC pericardial bioprosthesis performed well in a period of 11 years with low rates of fatal complication, ruptures, and thromboembolism without the use of anticoagulants. Calcification was the major complication mainly in youngsters.

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Estudo comparativo entre válvulas biológicas e válvulas mecânicas nas posições mitral ou aórtica até 14 anos

Cited by 3 publications

References 5 publications

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

Anticoagulação oral em portadores de próteses valvares cardíacas mecânicas: experiência de dez anos

Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position

IMC Bovine Pericardial Valve: 11 Years

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