title: Mitral valve Carpentier-Edwards bioprosthetic replacement, thromboembolism, and anticoagulants.
abstract: Patients undergoing mitral valve replacement (MVR) using a bioprosthesis are frequently placed on long-term anticoagulant treatment, and thereby lose the main advantage conferred by the bioprosthesis. To assess predictive factors of the need for long-term anticoagulant treatment, 100 consecutive patients surviving bioprosthetic MVR between 1977 and 1987 were followed up. The estimated thromboembolism-free survival was 88.9% +/- 3.6% after 6 years of follow-up. Preoperative risk factors for thromboembolism were supraventricular arrhythmia (p = 0.013) and a history of thromboembolism (p = 0.039). Among the preoperative and postoperative factors, only postoperative rhythm significantly influenced (p = 0.007) the thromboembolism-free survival, as determined by Cox regression analysis. Permanent anticoagulant treatment was instituted in 39 patients. Preoperative and peroperative risk factors associated with the need for long-term anticoagulant treatment, as evidenced by Fisher linear discriminant analysis, were supraventricular arrhythmia (p < 0.001), septal myotomy (p = 0.013), and predominant mitral stenosis (p = 0.013). Thus, in those patients with predominant mitral stenosis and supraventricular arrhythmia preoperatively, the subsequent need for permanent postoperative anticoagulant treatment is high, and the implantation of a mechanical valve is therefore recommended, providing there are no strict contraindications to anticoagulant treatment.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, University Hospital of Mont Godinne (Yvoir), Belgium.
authors.forename: Y A
authors.initials: YA
authors.lastname: Louagie
authors.forename: J
authors.initials: J
authors.lastname: Jamart
authors.forename: P
authors.initials: P
authors.lastname: Eucher
authors.forename: M
authors.initials: M
authors.lastname: Buche
authors.forename: J C
authors.initials: JC
authors.lastname: Schoevaerdts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000601:surgery; D001705:Bioprosthesis; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants