title: Low dose anticoagulation after St. Jude Medical prosthesis implantation in patients under 18 years of age.
abstract: Between September 1986 and January 1994, 129 St. Jude Medical prostheses were implanted in 113 patients who were 18-year-old or younger at the Cardiovascular Surgery Clinic of Turkiye Yuksek Ihtisas Hospital. Thirty-seven patients underwent aortic, 60 patients mitral and the remaining 16 patients double valve replacement. Overall hospital mortality was 7.9% (9/113). All patients received 2.5 mg/day warfarin from the first postoperative day, in addition 225 mg/day dipyridamole and 100 mg/day aspirin was given following the removal of mediastinal tubes. This regimen was continued indefinitely thereafter. Follow up period ranged between 2-94 months. Total follow up experience was 276.4 patient-years. There were five late deaths; the cause of death was prosthetic valve thrombosis in two patients, intracerebral hemorrhage in one, cardiomyopathy in one, and sudden death in one. Other late complications included one endocarditis, a further anticoagulant related bleeding and one paravalvular leak. There was no case of cerebral or peripheral embolism reported. Seven-year actuarial survival was 92.4 +/- 6.8% for the entire group, 84.6 +/- 13.8% after mitral and 100% after aortic or double valve replacement. In conclusion, low dose oral anticoagulation after heart valve replacement with St. Jude Medical prosthesis in this age group showed satisfactory clinical results.
authors.affiliation: Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Yamak
authors.forename: E
authors.initials: E
authors.lastname: Sener
authors.forename: U
authors.initials: U
authors.lastname: Kiziltepes
authors.forename: K
authors.initials: K
authors.lastname: Gol
authors.forename: O
authors.initials: O
authors.lastname: Tarcan
authors.forename: B
authors.initials: B
authors.lastname: Mavitas
authors.forename: O
authors.initials: O
authors.lastname: Tasdemir
authors.forename: K
authors.initials: K
authors.lastname: Bayazit
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001021:Aortic Valve; D001241:Aspirin / Q000627:therapeutic use; D004176:Dipyridamole / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000401:mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve; D011184:Postoperative Period; D012189:Retrospective Studies; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D004176:Dipyridamole; D001241:Aspirin