Thrombotic and Bleeding Complications of Prosthetic Heart Valves

Edmunds, L. Henry

doi:10.1016/s0003-4975(10)63816-7

Cited by 260 publications

(75 citation statements)

References 186 publications

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“…The rate of thromboembolism is consistent with the available literature on prosthetic and repair series [21]. The main difference in our series is the absence of anticoagulation in all patients, irrespective of their rhythm, except those with mechanical valves.…”

Section: Discussionsupporting

confidence: 91%

Heart Valve Surgery in a Young Predominantly Rheumatic Population

et al. 1993

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, 802 Saudi patients underwent 1,171 open valve surgical procedures at King Faisal Specialist Hospital and Research Centre (KFSH&RC). The mean age was 32.4 years (range one to 90). The etiology was rheumatic in 66.3.%, congenital in 12.8%, degenerative in 8.7%, infective in 5.9% and ischemic in 2%. The mean preoperative New York Heart Association (NYHA) functional class was 2.94 and 74% of the patients were in sinus rhythm. Multiple valve procedures were required in 39.4% of the cases and 718 valves (64.6%) were repaired. The overall hospital mortality was 4.48%. The mortality for isolated mitral valve repair was 1.8% against 3.48% for replacement. For isolated aortic repair, it was 0 against 8.5% for replacement. The follow-up of our patients was 98.1%. During the follow-up period of 1,171.06 patient years, the total incidence of thromboembolic events was 2.35% or 1.53% pt-yrs. Reoperation was required in 7.3% of the patients. The main cause was dysfunction of the rheumatic mitral repairs in the young patients. The late mortality was 3.78%. The actuarial survival for the total 802 operated patients was 86.27%. This survival was 91.10% for those undergoing repair versus 82.10% for those with replacement (P<0.005). It is concluded that a careful and complete follow-up of our patients is essential to determine the value of the available surgical techniques. The young rheumatic patient, so prevalent in our population, remains a surgical challenge. New surgical alternatives are needed. Ann Saudi Med 1993;13(6):501-507.CMG Duran, B Gometza, E Saad, Z Al-Halees, F Khouqeer, A Al-Sanei, Heart Valve Surgery in a Young Predominantly Rheumatic Population. 1993; 13(6): 501-507Valve replacement is an established surgical treatment for severe valvular disease. There is still a considerable debate on the selection of the appropriate prosthesis because of the limited durability of the presently available tissue valves which do not need anticoagulation, and the durable mechanical prosthesis which requires life-long anticoagulation. These problems become more acute in our very young population where the bioprostheses degenerate more rapidly and satisfactory anticoagulation is difficult. The frequent pregnancies further reduce the longevity of the bioprosthesis and complicate the treatment with warfarin. More recently, valve repair has been shown to offer considerable advantages over replacement [1][2][3][4][5][6]. These new techniques have been applied extensively in areas where the predominant pathology is degenerative or ischemic disease. There is, however, evidence that the long-term results are dependent on the underlying pathology and that repair in the rheumatic patient is less stable [7][8][9][10][11]. In our Centre, the presence of a large volume of young, predominantly rheumatic patients, coupled with first rate facilities for their diagnosis and treatment, offered a unique opportunity for the evaluation of the different surgical alternatives. A painstaking effort to achieve a complete follow-up of our patients has resu...

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Section: Discussionsupporting

confidence: 91%

Heart Valve Surgery in a Young Predominantly Rheumatic Population

et al. 1993

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“…Although the use of mechanical heart valves (MHVs) as a long-term therapy is far superior to any drug treatment offered to date, mechanical valves are at significant risk of causing platelet rupture, hemolysis and thromboembolisms, all of which prove unfavorable to longterm use (60). Note that such deleterious effects are mostly not observed with bioprosthetic heart valves, which have structural longevity problems of their own.…”

Section: Mechanical Heart Valves and Thrombosismentioning

confidence: 99%

“…Indeed, if it is true that platelets are sensitive to shear stress, the precise mechanism has yet to be defined. One such explanation introduces the possibility of shear-stress induced deformations/conformational changes in platelet membrane receptors or the cytoskeleton, which may then be converted to a biological response in the cell (64,60). Additional speculations introduce an actual shear-stress receptor on the cell-surface, or question the relevance of the platelet discoid shape and membrane structure with regards to facilitating platelet activation.…”

Section: Cellular and Subcellular Platelet Biomechanics In The Literamentioning

confidence: 99%

A mechanobiological investigation of platelets

McGrath

Mealing

Labrosse

2010

Biomech Model Mechanobiol

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“…This is particularly true for patients with aortic bioprostheses, in whom even platelet inhibitors may be unnecessary. 22 No randomized, controlled studies of platelet inhibitors in patients with bioprostheses have been reported. In an uncontrolled trial,97 long-term aspirin was associated with a low incidence of embolism in these patients.…”

Section: Prosthetic Valvesmentioning

confidence: 99%