Risk Factors for Tromboembolism Events in Patients Undergoing Bioprosthetic Mitral Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGLin ,  JIANGSheng-li , RENChong-lei , XIAOCang-song , WANGRong , GAOChang-qing

Department of Cardiovascular Surgery, Chinese PLA General Hospital, PLA Institute of Cardiac Surgery, Beijing 100853, P. R. China;

Corresponding author：

JIANGSheng-li, Email: jiangsl301@sina.com

Keywords：

Systemic embolism; Bioprosthetic mitral valve replacement; Antithrombotic therapy

DOI：

10.7507/1007-4848.20150115

Video：

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Objective To investigate the risk or protective factors for systemic embolism (SE) in patients undergoing bioprosthetic mitral valve replacement (MVR). Methods Between October 2002 and March 2013, a total of 146 patients underwent bioprosthetic MVR. There were 78 females and 68 males with mean age of 66.23±5.17 years. The primary reason of mitral valve disease was mitral valve degeneration or mitral valve leaflet prolapse in 40 patients, rheumatic heart valve disease in 101 patients, ischemic heart disease in 3 patients, infectious endocarditis in 1 patient, and mechanical peri-valvular leak in 1 patient. All patients were given anticoagulation therapy with warfarin for 3 months. Thereafter, antithrombotic medication was prescribed according to the surgeon's preference. The patients were followed up by telephone or mail for postoperative condition and SE events. Results Sixteen (10.96%) patients developed SE events, including cerebral infarction in 13 cases, transient ischemic attack (TIA) in 2 cases and spleen infarction in 1 case. A total of 16 patients died during follow-up. The 1-year, 3-year, 5-year and 10-year cumulative survival rate after surgery was 95.2%, 93.6%, 92.5% and 88.3% respectively. Patients with SE events had lower rate of left atrial appendage obliteration than those without SE events (25.0% vs. 78.6%, P=0.015). Multivariate analysis showed that left atrial appendage obliteration was an independent protective factor for SE in patients undergoing bioprosthetic MVR (P=0.041). Conclusion Left atrial appendage obliteration is a major protective factor for systemic embolism in patients undergoing bioprosthetic MVR no matter what antithrombotic medication is taken.

Citation： ZHANGLin, JIANGSheng-li, RENChong-lei, XIAOCang-song, WANGRong, GAOChang-qing. Risk Factors for Tromboembolism Events in Patients Undergoing Bioprosthetic Mitral Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 438-441. doi: 10.7507/1007-4848.20150115 Copy

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3.	Vahanian A, Alferi O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012):the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Toracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4):S1-S44.
4.	Colli A, D'Amico R, Mestres CA, et al. Is early antithrombotic therapy necessary after tissue mitral valve replacement? J Heart Valve Dis, 2010, 19(4):405-411.
5.	Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol, 1995, 25(5):1111-1119.
6.	Edmunds LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Torac Surg, 1987, 44(4):430-445.
7.	Taylor J. ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J, 2012, 33(19):2371-2372.
8.	Schwann TA, Engoren M, Bonnell M, et al. Mitral valve repair and bioprosthetic replacement without postoperative anticoagulation does not increase the risk of stroke or mortality. Eur J Cardiothorac Surg, 2013, 44(1):24-31.
9.	Brennan JM, Alexander KP, Wallace A, et al. Patterns of anticoagulation following bioprosthetic valve implantation:observations from ANSWER. J Heart Valve Dis, 2012, 21(1):78-87.
10.	Massel DR, Little SH. Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev, 2013, 7:CD003464.
11.	Colli A, Verhoye JP, Heijmen R, et al. Low-dose acetyl salicylic acid versus oral anticoagulation after bioprosthetic aortic valve replacement. Final report of the ACTION registry. Int J Cardiol, 2013, 168(2):1229-1236.
12.	Atak R, Turhan H, Senen K, et al. Relationship between control of ventricular rate in atrial fibrillation and systemic coagulation activation in patients with mitral stenosis. J Heart Valve Dis, 2004, 13(2):159-164.
13.	Fukuda N, Hirai T, Ohara K, et al. Relation of the severity of mitral regurgitation to thromboembolic risk in patients with atrial fbrillation. Int J Cardiol, 2011, 146(2):197-201.
14.	Kaya H, Ertas F, Kaya Z, et al. Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation:Results from Atrial Fibrillation in Turkey:Epidemio logic Registry (AFTER). Cardiol J, 2014, 21(2):158-162.

1. Vahanian A, Alferi O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19):2451-2496.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22):2489.
3. Vahanian A, Alferi O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012):the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Toracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4):S1-S44.
4. Colli A, D'Amico R, Mestres CA, et al. Is early antithrombotic therapy necessary after tissue mitral valve replacement? J Heart Valve Dis, 2010, 19(4):405-411.
5. Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol, 1995, 25(5):1111-1119.
6. Edmunds LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Torac Surg, 1987, 44(4):430-445.
7. Taylor J. ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J, 2012, 33(19):2371-2372.
8. Schwann TA, Engoren M, Bonnell M, et al. Mitral valve repair and bioprosthetic replacement without postoperative anticoagulation does not increase the risk of stroke or mortality. Eur J Cardiothorac Surg, 2013, 44(1):24-31.
9. Brennan JM, Alexander KP, Wallace A, et al. Patterns of anticoagulation following bioprosthetic valve implantation:observations from ANSWER. J Heart Valve Dis, 2012, 21(1):78-87.
10. Massel DR, Little SH. Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev, 2013, 7:CD003464.
11. Colli A, Verhoye JP, Heijmen R, et al. Low-dose acetyl salicylic acid versus oral anticoagulation after bioprosthetic aortic valve replacement. Final report of the ACTION registry. Int J Cardiol, 2013, 168(2):1229-1236.
12. Atak R, Turhan H, Senen K, et al. Relationship between control of ventricular rate in atrial fibrillation and systemic coagulation activation in patients with mitral stenosis. J Heart Valve Dis, 2004, 13(2):159-164.
13. Fukuda N, Hirai T, Ohara K, et al. Relation of the severity of mitral regurgitation to thromboembolic risk in patients with atrial fbrillation. Int J Cardiol, 2011, 146(2):197-201.
14. Kaya H, Ertas F, Kaya Z, et al. Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation:Results from Atrial Fibrillation in Turkey:Epidemio logic Registry (AFTER). Cardiol J, 2014, 21(2):158-162.

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Risk Factors for Tromboembolism Events in Patients Undergoing Bioprosthetic Mitral Valve Replacement

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