1
|
Sawa S, Saito S, Morita K, Miyamoto S, Hattori M, Hino A, Okuzono Y, Shiozaki Y, Echie Y, Niinami H. Thirty-year outcomes of low-intensity anticoagulation for mechanical aortic valve. Heart Vessels 2024; 39:549-555. [PMID: 38393378 DOI: 10.1007/s00380-024-02365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
The long-term safety, efficacy, and outcomes of low-intensity anticoagulation for mechanical heart valves remain unclear. This study aimed to evaluate the long-term outcomes of low-intensity anticoagulation therapy after aortic valve replacement (AVR) with a mechanical prosthesis. This retrospective cohort study consulted medical records and conducted a questionnaire to investigate 519 patients who underwent single AVR with the St. Jude Medical bileaflet valve and were in sinus rhythm. All patients were followed up with an international normalized ratio (INR) target of 1.6-2.5, and their INR values were checked throughout the follow-up period. The survival rate, incidence of major adverse cardiac and cerebrovascular events (MACCE), and risk factors for cardiac death and MACCE were investigated. The total follow-up was 9793 patient-years, and the follow-up periods were 19.9 (standard deviation [SD]: 7.9) years. The mean INR was 2.03 (SD: 0.54). Survival rates from cardiac death were 93.6% in 20 years and 85.2% in 30 years. Advanced age ≥ 70 years was the only significant risk factor for cardiac death and MACCE, and the INR < 2.0 was not significant risk factor for MACCE including thromboembolism or bleeding events. Low-intensity anticoagulation with an INR of 1.6-2.5 for patients with sinus rhythm after AVR with a bileaflet mechanical valve is safe and effective, even over 30 years.
Collapse
Affiliation(s)
- Shintaro Sawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan.
| | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Kozo Morita
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Shinka Miyamoto
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Masashi Hattori
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Atomu Hino
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Yasuhito Okuzono
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Yuji Shiozaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Yuki Echie
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, Tokyo, 162-8666, Japan
| |
Collapse
|
2
|
Santarpino G, Di Mauro M, De Feo M, Menicanti L, Paparella D, Mastroroberto P, Speziale G, Pollari F, Mauro M, Torella M, Coscioni E, Barili F, Parolari A. Mechanical heart valves and oral anticoagulation: a survey of the Italian Society of Cardiac Surgery. J Cardiovasc Med (Hagerstown) 2024; 25:38-43. [PMID: 38051658 DOI: 10.2459/jcm.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
In the latest European guidelines for the management of valvular heart disease, mechanical valve prostheses maintain a strategic role, particularly for certain patient subsets and age groups. Despite the high number of devices implanted in clinical practice, particularly in non-European and North American regions, current scientific literature and debate seem to suggest a limited use of mechanical heart valves. The cardiac surgery community seems to be highly interested in biological and transcatheter valve prostheses but less interested in mechanical heart valves, including possible strategies for self-management of anticoagulation therapy. In this respect, the Italian Society of Cardiac Surgery (SICCH), in particular the Italian Group of Research for Outcome in Cardiac Surgery (GIROC), has promoted a survey among its members to stimulate the interest in this topic and express their opinion on this issue that, due to the prevalence of the affected population and the new treatment options for improving patients' quality of life, should be more appraised and debated in the cardiac surgery community. The recorded results, obtained on the answers to 111 questionnaires, seem to divide the specialists into 'pros' and 'contras' on a useful tool for the entire cardiac surgery community. For this reason, SICCH proposes in conclusion to declare its unified and institutional opinion on this topic.
Collapse
Affiliation(s)
- Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Marisa De Feo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Napoli
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS, Policlinico San Donato, San Donato Milanese
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro
| | - Giuseppe Speziale
- Division of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari
| | - Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Marianna Mauro
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro
| | - Michele Torella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Napoli
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Fabio Barili
- Department of Cardiac Surgery, Santa Croce Hospital, Cuneo
| | - Alessandro Parolari
- University Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| |
Collapse
|