Eleven-Year Single-Center Experience with the ATS Open Pivot Bileaflet Heart Valve

Clinical Features and Survival Analysis of Patients after Mechanical Heart Valve Replacement, with an Emphasis on Prosthetic Valve Thrombosis

BACKGROUND

Valvular heart diseases are highly prevalent in the world, and surgical valve replacement has improved patients' survival.

OBJECTIVES

To describe clinical and laboratory data of patients undergoing mechanical valve replacement, and to determine the incidence of prosthetic valve thrombosis (PVT).

METHODS

Retrospective cohort study with a follow-up of up to nine years. The study variables were collected from conventional and electronic medical charts. Statistical calculations were performed using the Jamovi software version 1.2.2.; a p<0.05 was considered statistically significant. Kaplan Meier curves were constructed, and Cox regression analysis was performed for analysis of factors related to mortality.

RESULTS

A total of 473 patients were included, mean age of 46.9 ±11.3 years. Rheumatic disease was the most common etiology. In a mean follow-up period of 4.43 years, mortality rate was 16.1%. Patients with aortic prosthesis showed higher survival than patients with double implant (mitral and aortic) (p=0.026). Of the factors adjusted for mortality, only functional class and chronic renal failure showed statistically significant association. The incidence of PVT was 0.24/100 patients/year, and the first event occurred more than 1000 days after the implant. Smoking and pannus formation were significantly associated with PVT. No differences were found in INR variability between patients with and without thrombosis by prosthetic position, but significant differences were found in INR before thrombosis as compared with patients without thrombosis (INR= 2.20 [1.80-2.20] vs. 2.80 [2.20-3.40]; p= 0.040). The incidence of stroke and bleeding was 4.4% and 5.2% respectively.

CONCLUSIONS

The study population was young, and rheumatic valve disease was common in this group. The prevalence of PVT was similar to that described in the literature, despite the low income and low educational level of our sample.

Nineteen Years of Single Institute Experiences with Sorin Bicarbon Prosthesis

Purpose: We want to share our experience of Sorin Bicarbon prosthesis (SBP) after 19 years follow-up.

Methods: Retrospective study of 1377 patients who had replaced with SBP from May 1998 to December 2008 at Ho Chi Minh Heart Institute, Viet Nam.

Results: Male patients was 42%, mean age was 40.2 ± 11.8 years. Atrial fibrillation was 43.5%. The main cause of valvular disease was rheumatic fever (89.8%). Isolated mitral valve replacement (MVR): 54% (744), isolated aortic valve replacement (AVR): 18% (247), double valve replacement (DVR): 26% (359), and 27 AVR plus mitral repair. 30-day mortality for all was 1.5%. Mean time of follow-up was 153 ± 53.1 months with total follow-up time was 17563 patients-years. 2.5% lost of follow-up. Late death was 77 cases. Redo for all causes was 59 cases. 19 years survival was 88.8 ± 1.8%. 19 years freedom of redo was 76.4 ± 4.7%. Linearized rate of all valve thrombosis, embolism, severe bleeding, endocarditis, and pannus were 0.31%, 0.28%, 0.267%, 0.068%, and 0.165% patient-years, respectively.

Conclusions: SBP had shown very good results in long term and still have a reliable mechanical valve.

Valve-related complications after mechanical heart valve implantation

The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7-3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4-1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.

Clinical evaluation of new heart valve prostheses: update of objective performance criteria

This article summarizes the long-term clinical results of the Food and Drug Administration-approved heart valves, provides current updates to the objective performance criteria (OPC) used to evaluate new heart valve prostheses, and documents the steps that the International Organization for Standardization Committee used to arrive at the updated OPC. Data were extracted from 19 Food and Drug Administration summaries of safety and effectiveness data reports (31 series) and 56 literature articles (85 series) published from 1999 to 2012. The OPC were calculated for five valve-related complications by valve type (mechanical and bioprosthetic) and valve position (aortic and mitral).

CardiaMed mechanical valve: mid-term results of a multicenter clinical trial

BACKGROUND

Prosthesis choice is a major concern in valvular surgery.

METHODS

A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study.

RESULTS

The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1%  ± 3.7%; 86.1%  ± 4.8% and 84.4%  ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9%  ± 3.7% and 94.5%  ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8%  ± 3.1% and 93.8%  ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall).

CONCLUSION

The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

Twelve years of experience with the ATS mechanical heart valve prostheses

OBJECTIVE

The ATS Open Pivot mechanical heart valve has been implanted routinely at our institution since 1999. The objective of this study is to retrospectively analyze our 12-year clinical results with ATS prostheses.

METHODS

ATS Open Pivot mechanical valves were implanted in 268 adult patients between May 1999 and August 2010. We selected 259 subjects who could be adequately followed (follow-up rate 96.6 %). Aortic valve replacement was performed in 157 patients, mitral valve replacement (MVR) in 71, and double (aortic and mitral) valve replacements (DVR) in 31. Mean age at the time of implant was 58.8 ± 10.6 years. The gender ratio was 128 males/131 females. Mean follow-up was 4.4 ± 7.8 years, and the cumulative follow-up was 1144 patient-years (pt-yr).

RESULTS

Early death within 30 days after the operation occurred in 5 (2.5 %) patients. Late death occurred in 27 patients including valve-related deaths in 13. The 10-year survival rate after the operation was 82.7 ± 2.9 %. The rate of freedom from valve-related death was 92.2 ± 2.2 %. The incidence of valve-related complications was 2.19 %/pt-yr. Of these, the incidence of thromboembolic events and that of bleeding complications were 1.22 and that 0.87 %/pt-yr. The incidence of valve thrombosis was 0.09 %/pt-yr. No structural valve deterioration was observed in any of the three operative procedure groups.

CONCLUSIONS

Our 12-year experience with aortic and MVR using the ATS mechanical heart valve demonstrated low incidences of thromboembolic events, bleeding complications, and valve thrombosis.

Fifteen years of experience with ATS mechanical heart valve prostheses

BACKGROUND

ATS Medical, Inc, developed a mechanical heart valve that has been in use since 1992. In this article, we present the results of 15 years of follow-up of patients who have undergone ATS heart valve replacement at our hospital.

METHODS AND RESULTS

We performed ATS heart valve replacements on 231 patients between September 1993 and March 2008. Our operative mortality rate for the study period was 2.2%. The survival for postoperative thromboembolic events was 0.29%/pt-y for aortic valve replacement, 0.48%/pt-y for mitral, 0.80%/pt-y for double valve replacement, and overall 0.44%/pt-y. The survival after bleeding events was 0.29%/pt-y for aortic valve replacement, 0.16%/pt-y for mitral, 0%/pt-y for double valve replacement, and overall 0.19%/pt-y. Patient-prosthesis mismatch, as determined by echocardiography, was found in 83.3% of patients at 19 mm, but other sizes showed good valve function. Prosthetic valve noise was undetectable in 92.8% of patients, and quality of life was excellent.

CONCLUSIONS

Few prosthetic valve-related complications were seen with ATS heart valve replacements in this study, and the follow-up results were favorable. The international normalized ratio was maintained in the range 1.6 to 2.0 in patients with aortic valve replacement in sinus rhythm. Not only bleeding events, seen at a rate of 0.19%/pt-y, but also thromboembolic events, at 0.44%/pt-y, were low when compared with conventional mechanical valves. Prosthetic valve noise is low, and this appears to be an excellent mechanical valve from the quality of life standpoint. The ATS valve has an excellent safety profile when compared with other mechanical valves.

Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends

Over 4 million people worldwide have received a prosthetic heart valve, and an estimated 300,000 valves are being implanted every year. Prosthetic heart valves improve quality of life and survival of patients with severe valvular heart disease, but the need for antithrombotic therapy to prevent thrombotic complications in valve recipients poses challenges for clinicians and patients. Here, we review antithrombotic therapies for patients with prosthetic heart valves and management of thromboembolic complications. Advances in antithrombotic therapy and valve technologies are likely to improve the management of patients with prosthetic heart valves in developed countries, but the most important unmet need and potential for benefit from these new therapies is in developing countries where a massive and rapidly increasing burden of valvular heart disease exists.

Eight-year follow-up after prospectively randomized implantation of different mechanical aortic valves

OBJECTIVE

The aim of this prospectively randomized study was to evaluate the hemodynamic and functional outcomes after aortic valve replacement with three different bileaflet mechanical valves.

METHODS

From March 1996 to August 1998, 300 consecutive patients were randomly assigned to receive ATS (n = 100), Carbomedics (n = 100), or St Jude Medical Hemodynamic Plus (n = 100) mechanical aortic valve replacement. There were no significant differences regarding patient age (61 +/- 8 years), gender, NYHA, aortic valve pathology, ventricular morphology, ejection fraction and requirement for additional procedures at implant. Mean follow-up extends to 95 +/- 21 months at a total of 2,891 patients years and is in 95.3% complete.

RESULTS

Implanted valve sizes were comparable at 24 +/- 2 mm (ATS), 23.7 +/- 1.6 mm (CM), and 23.6 +/- 1.9 mm (SJMHP) (NS). Follow-up results were: transvalvular flow velocities 2.3/2.3/2.2 m/s, ejection fraction 64/59/63%, trivial transvalvular incompetence 3/3/2; paravalvular leak 2/3/2; freedom of reoperation 100/99/99%, NYHA functional status 1.5/1.8/1.6, overall survival 86.4/82.8/80.6%, freedom from thrombembolic events 100/96/98%, freedom from hemorrhage 100/100/99%, freedom from all valve related events was 100/96/98%; respectively (NS). There were no episodes of endocarditis. Ninety-four percent of the patients were satisfied with the procedure enjoying an enhanced daily life activity.

CONCLUSIONS

There are no clinically relevant differences among the tested bileaflet aortic valves. Regardless of valve type, there was a rather low complication rate in this relatively young population. All three bileaflet prostheses are well suited for aortic valve replacement.