title: Recurrent systemic embolic events with valve prosthesis.
abstract: Among 1436 patients who underwent valve replacement, the 400 first cases were studied to assess the features of recurrent systemic embolic event. The mean follow-up was 87 months. Three groups of patients were compared: groups A-289 patients without any thromboembolic event (72.25%); group B-78 patients with only one embolic event (19.5%); group C-33 patients with several embolic events (8.25%). The frequency of recurrence was high: one patient out of three (linearized mean 8.9% in group C considering only one recurrence, vs 3.8% in group B). The recurrence have the same location in 45% of patients. The consequences of these embolisms are serious; each event has a 30 to 40% risk of death or major disability. Four variables seem statistically to promote the occurrence of embolic events: mitral prostheses, pre-operative fibrillation, left atrial enlargement, poor anticoagulant therapy. 54 months after the first embolic event, 60% of the patients with poor anticoagulant therapy experience a recurrent thromboembolism vs 20% with adequate therapy. Twenty-six patients of groups B and C had a pathological study of prostheses. Thrombosis of the prostheses was found in 12 out of 18 patients in group B and in 7 out of 8 patients; in group C. Strict observance of anticoagulant therapy is the better way to prevent thromboembolism and especially recurrences. A reoperation is sometimes necessary. Valve re-replacement was performed in 27 cases out of 1436 patients.
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012306:Risk; D013923:Thromboembolism / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery
chemical_list: D000925:Anticoagulants