Thromboembolic Complications After Surgical Correction of Mitral Regurgitation

Russo, Antonio; Grigioni, Francesco; Avierinos, Jean-François; Freeman, William K.; Suri, Rakesh M.; Michelena, Héctor I.; Brown, Robert D.; Sundt, Thoralf M.; Enríquez-Sarano, Maurice

doi:10.1016/j.jacc.2007.10.058

Cited by 130 publications

(64 citation statements)

References 47 publications

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“…Atrial fibrillation precipitates TEs 13,18,41 with tissue MVR but not mechanical MVR, 6 which is similar to the results of the present study. Prosthesis type as a TE predictor is controversial.…”

Section: Effect Of Prosthesis Typesupporting

confidence: 90%

“…A secondary end point was bleeding complications. TEs and bleeding were defined in accordance with previous reports 6,27,28 and current guidelines, 26 along with a neurologic consultation to assess strokes. Bleeding within 48 h of cardiopulmonary bypass was not taken into account.…”

Section: Follow-up and Eventsmentioning

confidence: 99%

“…6 However, without a complete anticoagulation record, it was not possible to ascertain a relationship to anticoagulation or to mechanical MVR. Our complete populationbased data, including data on anticoagulation and TEs (which can be underestimated in observational series 8 ), indicate a high TE risk after mechanical MVR despite average on-target anticoagulation.…”

Section: Thromboembolic Riskmentioning

confidence: 99%

“…5 However, the indispensable anticoagulation has inherent substantial bleeding risk. 6,22 High TE and bleeding risks suggest that mechanical MVR is the least desirable mitral procedure and should be selected in young patients only when mitral valve repair is not feasible.…”

Section: Thromboembolic Riskmentioning

confidence: 99%

“…13 While high-visibility studies 14 suggested that TEs were exceptional with optimal anticoagulation, TEs remain a major problem after mechanical MVR, 6 and their link to anticoagulation quality remains controversial. 7,10,14 -19 Many studies 3,7,9,10,18,20,21 have analyzed convenience samples of mechanical MVR, but incomplete or sparse anticoagulation data have been usual.…”

mentioning

confidence: 99%

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Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

Tourneau

Lim

Inamo

et al. 2009

Chest

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Background: Thromboembolic events (TEs) are frequent after mechanical mitral valve replacement (MVR), but their association to anticoagulation quality is unclear and has never been studied in a population-based setting with patients who have a complete anticoagulation record. Conclusion: This population-based comprehensive study of anticoagulation and TE post-MVR shows that, in these closely anticoagulated patients, anticoagulation intensity was highly variable and not associated with TE incidence post-MVR. Higher anticoagulation intensity is linked to higher variability and, thus, to bleeding. The MVR-ball prosthesis design is associated with higher TE rates notwithstanding higher anticoagulation intensity, and its use should be retired worldwide.(CHEST 2009; 136:1503-1513)

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Section: Effect Of Prosthesis Typesupporting

confidence: 90%

Section: Follow-up and Eventsmentioning

confidence: 99%

Section: Thromboembolic Riskmentioning

confidence: 99%

Section: Thromboembolic Riskmentioning

confidence: 99%

mentioning

confidence: 99%

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Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

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Lim

Inamo

et al. 2009

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Survival and Outcomes Following Bioprosthetic vs Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years

Chikwe

Chiang

Egorova

et al. 2015

JAMA

115

108

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Evaluating Reference Ages for Selecting Prosthesis Types for Heart Valve Replacement in Korea

Park

Kim

et al. 2023

JAMA Netw Open

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ImportanceAlthough a patient’s age may be the only objective figure that can be used as a reference indicator in selecting the type of prosthesis in heart valve surgery, different clinical guidelines use different age criteria.ObjectiveTo explore the age-associated survival-hazard functions associated with prosthesis type in aortic valve replacement (AVR) and mitral valve replacement (MVR).Design, Setting, and ParticipantsThis cohort study compared the long-term outcomes associated with mechanical and biologic prostheses in AVR and MVR according to recipient’s age using a nationwide administrative data from the Korean National Health Insurance Service. To reduce the potential treatment-selection bias between mechanical and biologic prostheses, the inverse-probability-of-treatment-weighting method was used. Participants included patients who underwent AVR or MVR in Korea between 2003 and 2018. Statistical analysis was performed between March 2022 and March 2023.ExposuresAVR, MVR, or both AVR and MVR with mechanical or biologic prosthesis.Main Outcomes and MeasuresThe primary end point was all-cause mortality after receiving prosthetic valves. The secondary end points were the valve-related events, including the incidence of reoperation, systemic thromboembolism, and major bleeding.ResultsOf the total of 24 347 patients (mean [SD] age, 62.5 [7.3] years; 11 947 [49.1%] men) included in this study, 11 993 received AVR, 8911 received MVR, and 3470 received both AVR and MVR simultaneously. Following AVR, bioprosthesis was associated with significantly greater risks of mortality than mechanical prosthesis in patients younger than 55 years (adjusted hazard ratio [aHR], 2.18; 95% CI, 1.32-3.63; P = .002) and in those aged 55 to 64 years (aHR, 1.29; 95% CI, 1.02-1.63; P = .04), but the risk of mortality reversed in patients aged 65 years or older (aHR, 0.77; 95% CI, 0.66-0.90; P = .001). For MVR, the risk of mortality was also greater with bioprosthesis in patients aged 55 to 69 years (aHR, 1.22; 95% CI, 1.04-1.44; P = .02), but there was no difference for patients aged 70 years or older (aHR, 1.06; 95% CI, 0.79-1.42; P = .69). The risk of reoperation was consistently higher with bioprosthesis, regardless of valve position, in all age strata (eg, MVR among patients aged 55-69 years: aHR, 7.75; 95% CI, 5.14-11.69; P &lt; .001); however, the risks of thromboembolism and bleeding were higher in patients aged 65 years and older after mechanical AVR (thromboembolism: aHR, 0.55; 95% CI, 0.41-0.73; P &lt; .001; bleeding: aHR, 0.39; 95% CI, 0.25-0.60; P &lt; .001), with no differences after MVR in any age strata.Conclusions and RelevanceIn this nationwide cohort study, the long-term survival benefit associated with mechanical prosthesis vs bioprosthesis persisted until age 65 years in AVR and age 70 years in MVR.

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Thromboembolic Complications After Surgical Correction of Mitral Regurgitation

Cited by 130 publications

References 47 publications

Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

Survival and Outcomes Following Bioprosthetic vs Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years

Evaluating Reference Ages for Selecting Prosthesis Types for Heart Valve Replacement in Korea

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