Abstract:Sorin Bicarbon prosthesis provides excellent clinical results and mid-term survival with very low complication rates comparable with those of other bileaflet prostheses currently in use.
“…For this, it is essential to maintain the proper INR. The present study's results on the linearized occurrence rate of thromboembolism and actuarial event-free rates in the patients who maintained a low INR is similar to those of other reports [13-17]. …”
BackgroundWe investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement.Materials and MethodsSeventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)® dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively.ResultsThe observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were 97.10±2.02% at 5 years, 84.30±5.22% at 10 years, and 67.44±12.14% at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, 1.86±0.14 vs. thromboembolic group, 1.50±0.28, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, 49.04±9.47 days vs. thromboembolic group, 65.89±44.88 days, p<0.01).ConclusionTo prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.
“…For this, it is essential to maintain the proper INR. The present study's results on the linearized occurrence rate of thromboembolism and actuarial event-free rates in the patients who maintained a low INR is similar to those of other reports [13-17]. …”
BackgroundWe investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement.Materials and MethodsSeventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)® dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively.ResultsThe observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were 97.10±2.02% at 5 years, 84.30±5.22% at 10 years, and 67.44±12.14% at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, 1.86±0.14 vs. thromboembolic group, 1.50±0.28, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, 49.04±9.47 days vs. thromboembolic group, 65.89±44.88 days, p<0.01).ConclusionTo prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.
“…Comparing the mortality rates of our study to those of patients undergoing isolated valve replacement with a mechanical prosthesis in our institution, combined procedures of CABG and valve replacement showed a moderate increase in mortality rate of approximately 2.5% [ 6 ].…”
Objective: The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. Methods: The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. Results: There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82–5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45–9.07, p < 0.01) as independent predictors for lower long-term survival. Conclusions: Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.
“…[14]. Sezai ghi nhận ( trên siêu âm ) có đến 83,3% số BN thay van ĐMC cở 19mm bị PPM mức độ trung bình và nặng [23]. Một nghiên cứu với 3609 BN được thay van ĐMC của Kaminishi và CS cho thấy tỷ lệ PPM lên đến 8,5% và tỷ lệ tử vong sớm ở nhóm PPM là 3,9% gấp đôi so với nhóm không PPM [18].…”
Section: Bệnh Nhân Và Phương Pháp Nghiên Cứuunclassified
Nghiên cứu theo dõi dài hạn đã cho thấy van Sorin Bicarbon có hiệu năng tốt, tính tương thích cao và ít gặp biến chứng liên quan. - Về lâu dài, nhằm giảm thiểu biến chứng mô cơ tăng sinh gây rối loạn chức năng van ĐMC và tránh hiện tượng bất tương xứng van nhân tạobệnh nhân ở vị trí van ĐMC nên chọn kích cỡ van tương đương 21 trở lên .
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