Mitral valve replacement with St. Jude Medical prosthesis and low-dose anticoagulation in patients aged over 50 years.
OBJECTIVE
These studies were designed to assess the effect of low-dose anticoagulation in elderly patients after mitral valve replacement.


METHODS
Between 1986 and 1995, 250 patients aged > or = 50 years underwent isolated mitral valve replacement at the Cardiovascular Surgery Clinic of Turkiye Yuksek Ihtisas Hospital. The overall hospital mortality rate was 8%. Postoperatively, all patients received 2.5 mg/day warfarin, and 225 mg/day dypridamole and 250 mg/day aspirin following removal of mediastinal tubes. This regimen was continued indefinitely thereafter.


RESULTS
Postoperatively, the mean International Normalized Ratio (INR) was 1.4 +/- 0.67 (range: 0.9 to 4.19) and mean prothrombin time 13.33 +/- 1.98 min (range: 11.7 to 21.3 min). Mean follow up was 1.42 +/- 1.2 years (range: 2 months to 8.3 years); total cumulative follow up was 322.75 patient-years (pt-yr). During follow up, six patients (1.85% per pt-yr) developed thromboembolic complications (including mechanical valve thrombosis), two (0.62% per pt-yr) developed oral anticoagulant-related bleeding, and two (0.62% per pt-yr) developed paravalvular leak. Five patients died during follow up (late mortality rate 1.2% per pt-yr). The nine-year actuarial survival rate was 93.9 +/- 4.8% for the entire group.


CONCLUSIONS
Low-dose oral anticoagulation after mitral valve replacement with St. Jude Medical prosthesis in elderly patients provided satisfactory clinical results.
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
S F
SF
Katircioglu
B
B
Yamak
A T
AT
Ulus
O
O
Tasdemir
K
K
Bayazit
D000206:Actuarial Analysis; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000401:mortality / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin