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

Overview

Journal Arq Bras Cardiol

Specialty Cardiology & Vascular Diseases

Date 2022 Dec 1

PMID 36453764

Authors

Fabio Tagliari

Marcelo Goulart Correia

Guilherme Dalcol Amorim

Alexandre Siciliano Colafranceschi

Joao Manoel Pedroso

Luiz Fernando Rodrigues Junior

Thaisa Rodrigues Tagliari

Clara Weksler

Cristiane Lamas

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Research on rheumatic heart disease from 2013 to early 2024: a bibliometric analysis.

Chen Y, Wang L, Ma D, Cui Z, Liu Y, Pang Q J Cardiothorac Surg. 2024; 19(1):659.

PMID: 39702478 PMC: 11660848. DOI: 10.1186/s13019-024-03175-y.

Mechanical Valve Implants: What Are Their Long-Term Effects?Reply.

Marinho E, Santos J, Brito B, Andrade A, Lopes J Arq Bras Cardiol. 2023; 120(6):e20220875.

PMID: 37466489 PMC: 10364984. DOI: 10.36660/abc.20220875.

Prognosis and Characteristics Associated with Prosthetic Valve Thrombosis: Insights from a Brazilian Study.

Dutra G, Gomes B Arq Bras Cardiol. 2022; 119(5):745-746.

PMID: 36453765 PMC: 9750219. DOI: 10.36660/abc.20220739.

References

Montera M, Colafranceschi A, Kiyose A, Fiorelli A, Bacelar A, de Santis Andrade Lopes A . [Brazilian Guidelines for Valve Disease - SBC 2011 / I Guideline Inter-American Valve Disease - 2011 SIAC]. Arq Bras Cardiol. 2012; 97(5 Suppl 1):1-67. DOI: 10.1590/s0066-782x2011002000001. View

Van Nooten G, Caes F, Francois K, Van Bellleghem Y, Bove T, Vandenplas G . Twenty years' single-center experience with mechanical heart valves: a critical review of anticoagulation policy. J Heart Valve Dis. 2012; 21(1):88-98. View

Caceres-Loriga F . Heparin in the treatment of prosthetic valve thrombosis. Heart Lung Circ. 2014; 24(4):423. DOI: 10.1016/j.hlc.2014.11.006. View

Pibarot P, Dumesnil J . Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009; 119(7):1034-48. DOI: 10.1161/CIRCULATIONAHA.108.778886. View

Poli D, Antonucci E, Pengo V, Migliaccio L, Testa S, Lodigiani C . Mechanical prosthetic heart valves: Quality of anticoagulation and thromboembolic risk. The observational multicenter PLECTRUM study. Int J Cardiol. 2018; 267:68-73. DOI: 10.1016/j.ijcard.2018.04.042. View

de Aquino Xavier R, Azevedo V, Godoy P, Migowski A, Ribeiro A, Chaves R . Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study. BMC Cardiovasc Disord. 2017; 17(1):302. PMC: 5745641. DOI: 10.1186/s12872-017-0725-9. View

Gursoy M, Kalcik M, Yesin M, Karakoyun S, Bayam E, Gunduz S . A global perspective on mechanical prosthetic heart valve thrombosis: Diagnostic and therapeutic challenges. Anatol J Cardiol. 2016; 16(12):980-989. PMC: 5324921. DOI: 10.14744/AnatolJCardiol.2016.7486. View

Desai S, Kavinsky C . Localized left atrial administration of tPA for the treatment of mechanical mitral valve thrombosis. Catheter Cardiovasc Interv. 2008; 72(2):151-5. DOI: 10.1002/ccd.21585. View

Iung B, Vahanian A . Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011; 8(3):162-72. DOI: 10.1038/nrcardio.2010.202. View

10.

Dangas G, Weitz J, Giustino G, Makkar R, Mehran R . Prosthetic Heart Valve Thrombosis. J Am Coll Cardiol. 2016; 68(24):2670-2689. DOI: 10.1016/j.jacc.2016.09.958. View

11.

Karthikeyan G, Senguttuvan N, Joseph J, Devasenapathy N, Bahl V, Airan B . Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies. Eur Heart J. 2013; 34(21):1557-66. DOI: 10.1093/eurheartj/ehs486. View

12.

Koertke H, Zittermann A, Wagner O, Secer S, Sciangula A, Saggau W . Telemedicine-guided, very low-dose international normalized ratio self-control in patients with mechanical heart valve implants. Eur Heart J. 2014; 36(21):1297-305. DOI: 10.1093/eurheartj/ehu330. View

13.

Tan C, Fong A, Jong Y, Ong T . INR Control of Patients with Mechanical Heart Valve on Long-Term Warfarin Therapy. Glob Heart. 2018; 13(4):241-244. DOI: 10.1016/j.gheart.2018.08.003. View

14.

Baykut D, Grize L, Schindler C, Keil A, Bernet F, Zerkowski H . Eleven-year single-center experience with the ATS Open Pivot Bileaflet heart valve. Ann Thorac Surg. 2006; 82(3):847-52. DOI: 10.1016/j.athoracsur.2006.04.042. View

15.

Tominaga R, Kurisu K, Ochiai Y, Tomita Y, Masuda M, Morita S . A 10-year experience with the Carbomedics cardiac prosthesis. Ann Thorac Surg. 2005; 79(3):784-9. DOI: 10.1016/j.athoracsur.2004.08.067. View

16.

Lima M, Vieira M . Mechanical prosthetic valve thrombosis. Arq Bras Cardiol. 2009; 93(3):e57. DOI: 10.1590/s0066-782x2009000900023. View

17.

Lengyel M, Horstkotte D, Voller H, Mistiaen W . Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis. 2005; 14(5):567-75. View

18.

Hammermeister K, Sethi G, Henderson W, Grover F, Oprian C, Rahimtoola S . Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000; 36(4):1152-8. DOI: 10.1016/s0735-1097(00)00834-2. View

19.

Ozkan M, Gunduz S, Gursoy O, Karakoyun S, Astarcioglu M, Kalcik M . Ultraslow thrombolytic therapy: A novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial. Am Heart J. 2015; 170(2):409-18. DOI: 10.1016/j.ahj.2015.04.025. View

20.

Sousa C, Almeida J, Dias P, Almeida P, Rangel I, Araujo V . Conservative management of a prosthetic valve thrombosis--report of a successful case. Heart Lung Circ. 2014; 23(10):e207-9. DOI: 10.1016/j.hlc.2014.04.257. View