Impact of postoperative duration of Aspirin use on longevity of bioprosthetic pulmonary valve in patients who underwent congenital heart disease repair

Hwang, Tae-Yeon; Kim, Sung Ook; Lee, Sangyun; Kim, Seong Ho; Choi, Eun Young; Jang, So Ick; Park, Su Jin; Kwon, Hye Won; Lim, Hyo Bin; Lee, Chang Ha

doi:10.3345/kjp.2016.59.11.446

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Regarding the indication to aspirin therapy in patients with a prosthetic valve on the RVOT, there are conflicting opinions. Tae-Woong Hwang et al showed that daily aspirin does not give any benefit after 6 months from operation in patients who underwent pulmonary valve replacement with a bioprosthetic valve [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Aspirin Management in Redo Tetralogy of Fallot Population: Single Centre Experience

et al. 2020

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Purpose: Redo operations and preoperative antiplatelet/anticoagulant therapy can significantly increase surgical risk in congenital heart surgery. This is a retrospective study on the impact of preoperative aspirin therapy on the outcome of Tetralogy of Redo Fallot patients undergoing right ventricle outflow tract (RVOT) conduit implantation. Methods: Ten-years retrospective analysis of medical records was carried out. A total of 72 patients were divided into two groups: “Daily-on-ASA” group on daily therapy with aspirin (ASA) until 5 days from surgery and “No-Home-ASA” without it. Propensity match analysis was done in order to standardize the populations. Intraoperative and postoperative lengths were compared as well as the need for inotropic support. In addition, differences in blood transfusions and need for Fresh frozen plasma (FFP)/platelets (PLT) were analysed. Findings: Intraoperative lengths were similar between the groups. Not statistically significative differences about postoperative time to extubation (p = 0.34), ICU Stay (p = 0.31) or in-hospital stay (p = 0.36) were found. Drain loss was higher in the “Daily-on-ASA” group (407.9 ± 96.7 mL vs. 349.5 ± 84.3 mL; p = 0.03) as well as blood transfusions (372.7 ± 255.1 mL vs. 220.1 ± 130.3 mL, p = 0.02) and PLT/FFP need (217.7 ± 132.1 mL vs. 118.7 ± 147.1 mL, p = 0.01). No differences were found in postoperative complications or re-explorations for bleeding. Implications: We found no advantages in surgical times and hospital stay comparing redo patients who stopped aspirin versus those that didn’t take it in the last 6 months. However, our results suggest that redo patients undergoing RVOT conduit implantation who take daily aspirin are at higher risk of bleeding even if it is stopped 5 days before surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative Aspirin Management in Redo Tetralogy of Fallot Population: Single Centre Experience

et al. 2020

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“…It is noteworthy that current guidelines, including those related to valvular and congenital heart conditions, do not address medical therapy after pulmonic bio prosthesis replacement. However, no benefit has been observed from long-term medication (>6 months) after pulmonary valve replacement using a bioprosthetic valve [72].…”

Section: Antiplatelet Agents After Device Implantationmentioning

confidence: 99%

Cardiac Drugs in ACHD Cardiovascular Medicine

Ladouceur

Valdeolmillos

Karsenty

et al. 2023

JCDD

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Adult congenital heart disease (ACHD) is a growing population that requires life-long care due to advances in pediatric care and surgical or catheter procedures. Despite this, drug therapy in ACHD remains largely empiric due to the lack of clinical data, and formalized guidelines on drug therapy are currently lacking. The aging ACHD population has led to an increase in late cardiovascular complications such as heart failure, arrhythmias, and pulmonary hypertension. Pharmacotherapy, with few exceptions, in ACHD is largely supportive, whereas significant structural abnormalities usually require interventional, surgical, or percutaneous treatment. Recent advances in ACHD have prolonged survival for these patients, but further research is needed to determine the most effective treatment options for these patients. A better understanding of the use of cardiac drugs in ACHD patients could lead to improved treatment outcomes and a better quality of life for these patients. This review aims to provide an overview of the current status of cardiac drugs in ACHD cardiovascular medicine, including the rationale, limited current evidence, and knowledge gaps in this growing area.

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“…Antiplatelet therapy was used in only 50% of studies. Aspirin was used as monotherapy in bioprosthetic pulmonary valve (PV) replacement in a study aiming to determine the optimal duration of therapy ( 18 ). Those researchers found that short courses (approximately 6 months) of aspirin as primary prevention were non-inferior to using aspirin for ≥12 months.…”

Section: Valvesmentioning

confidence: 99%

“…Specifics on bleeding episodes were inconsistently reported, though in the study with the highest percentage (16.6%), the events were characterized as chronic subdural hematomas diagnosed 1–7 months after MV replacement, all while on warfarin ( 20 ). Thromboembolic incidence ranged from 0–36.3% across studies ( 18 , 19 , 21 , 28 – 32 ). Dos et al reported a high rate of thromboembolism (36.3%), although these events occurred in only 9% of patients, as eight thrombotic events occurred between two patients, many occurring months to years valve surgery ( 21 ).…”

Section: Valvesmentioning

confidence: 99%

A Narrative Review of Postoperative Anticoagulation Therapy for Congenital Cardiac Disease

et al. 2022

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Congenital heart disease encompasses a range of cardiac birth defects. Some defects require early and complex surgical intervention and post-operative thromboprophylaxis primarily for valve, conduit, and shunt patency. Antiplatelet and anticoagulant management strategies vary considerably and may or may not align with recognized consensus practice guidelines. In addition, newer anticoagulant agents are being increasingly used in children, but these medications are not addressed in most consensus statements.This narrative review evaluated the literature from 2011 through 2021 on the topic of postoperative thromboprophylaxis after congenital heart disease operations. The search was focused on the descriptions and results of pediatric studies for replacement and/or repair of heart valves, shunts, conduits, and other congenital heart disease operations. Wide variability in practice exists and, as was true a decade ago, few randomized controlled trials have been conducted. Aspirin, warfarin, and perioperative heparin remain the most commonly used agents with varying dosing, duration, and monitoring strategies, making comparisons difficult. Only recently have data on direct oral anticoagulants been published in children, suggesting evolving paradigms of care. Our findings highlight the need for more research to strengthen the evidence for standardized thromboprophylaxis strategies.

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Impact of postoperative duration of Aspirin use on longevity of bioprosthetic pulmonary valve in patients who underwent congenital heart disease repair

Cited by 3 publications

References 16 publications

Preoperative Aspirin Management in Redo Tetralogy of Fallot Population: Single Centre Experience

Preoperative Aspirin Management in Redo Tetralogy of Fallot Population: Single Centre Experience

Cardiac Drugs in ACHD Cardiovascular Medicine

A Narrative Review of Postoperative Anticoagulation Therapy for Congenital Cardiac Disease

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