The Risks and Benefits of Reoperative Aortic Valve Replacement

Gaudiani, Vincent A.; Grunkemeier, Gary L.; Castro, Luis J.; Fisher, Audrey L.; Wu, YingXing

doi:10.1532/hsf98.20041005

Cited by 14 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Future studies assessing the benefits of biologic valves in young patients will have to take into account the risks of reoperation compared with the risks of long-term anticoagulation. Recently, Gaudiani and associates, 34 using a risk model, showed the risks of reoperation with biologic valves to be comparable with the long-term risks of anticoagulation. Furthermore, development of selfmanagement INR-monitoring strategies might result in a decrease in anticoagulation-mediated morbidity and limit the benefits of use of biologic valves in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?

Dagenais¹,

Cartier²,

Voisine³

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?

Dagenais¹,

Cartier²,

Voisine³

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…At the same time, mortality of tissue valve re-operations has continually decreased over time. While it was over 40% in the 1960s/1970s (48), the operative mortality rate of a first reoperation in a modern series is 3%-4% for AVRs (49)(50)(51) and 4%-8% for MVRs (52,53).…”

Section: Balancing Harmmentioning

confidence: 99%

Mechanical valve replacement for patients with rheumatic heart disease: the reality of INR control in Africa and beyond

Zilla,

Human,

Pennel

2024

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

The majority of patients requiring heart valve replacement in low- to middle-income countries (LMICs) need it for rheumatic heart disease (RHD). While the young age of such patients largely prescribes replacement with mechanical prostheses, reliable anticoagulation management is often unattainable under the prevailing socioeconomic circumstances. Cases of patients with clotted valves presenting for emergency surgery as a consequence of poor adherence to anticoagulation control are frequent. The operative mortality rates of reoperations for thrombosed mechanical valves are several times higher than those for tissue valves, and long-term results are also disappointing. Under-anticoagulation prevails in these regions that has clearly been linked to poor international normalised ratio (INR) monitoring. In industrialised countries, safe anticoagulation is defined as >60%–70% of the time in the therapeutic range (TTR). In LMICs, the TTR has been found to be in the range of twenty to forty percent. In this study, we analysed >20,000 INR test results of 552 consecutive patients receiving a mechanical valve for RHD. Only 27% of these test results were in the therapeutic range, with the vast majority (61%) being sub-therapeutic. Interestingly, the post-operative frequency of INR tests of one every 3–4 weeks in year 1 had dropped to less than 1 per year by year 7. LMICs need to use clinical judgement and assess the probability of insufficient INR monitoring prior to uncritically applying Western guidelines predominantly based on chronological age. The process of identification of high-risk subgroups in terms of non-adherence to anticoagulation control should take into account both the adherence history of >50% of patients with RHD who were in chronic atrial fibrillation prior to surgery as well as geographic and socioeconomic circumstances.

show abstract

“…In the absence of cumulative revision rates and rigorous, continuous analysis, it is difficult to understand the value of new device models and processes. The absence of such data for joint prostheses can be contrasted with the rich history of survival modeling for heart valves which has led both to relative product stability and well-defined indications for product selection [ 7 , 20 ].…”

Section: Purchaser Concerns Regarding Orthopaedic Practicementioning

confidence: 99%

Quality Measurement in Orthopaedics: The Purchasers’ View

Lansky

Milstein

2009

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability.

show abstract

The Risks and Benefits of Reoperative Aortic Valve Replacement

Abstract: In this series, the risk of reoperation AVR is comparable with the published risks of long-term warfarin sodium (Coumadin) administration after mechanical AVR. Any adult who requires AVR may be well advised to consider tissue prostheses.

Cited by 14 publications

References 16 publications

Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?

Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?

Mechanical valve replacement for patients with rheumatic heart disease: the reality of INR control in Africa and beyond

Quality Measurement in Orthopaedics: The Purchasers’ View

Contact Info

Product

Resources

About