Fatal and moderate-to-severe long-term complications after mitral valve replacement
Abstract
Aim. To analyze the frequency of thromboses, thromboembolism and clinically significant hemorrhages developed in the long-term postoperative period from 5 to 7 years after isolated mitral valve replacement by the bivalve mechanical prostheses.
Material and methods. The study included 175 patients successfully operated in the Federal Centre for Surgery, Astrakhan, in 2011–2013. Gender ratio F:M was 116:63. Etiology of the mitral valve disease was the following: rheumatic disease 141 (80.6%), myxomatous degeneration 27 (15.4%), and infection endocarditis 7 (4%). 73 (41.7%) patients had permanent form of atrial fibrillation. Types of prostheses implanted: “On-X” – 8 (4.6%), “Carbomedics” – 69 (39.4%), “MedIng” – 94 (53.7%), “ATS” – 4 (2.3%). The standard procedures for MVR included the use of cardio-pulmonary bypass with mild hypothermia with Custodiol cardioplegic solution. The results were analyzed for the following parameters: thromboembolic complications, thrombosis of prostheses, and clinically significant hemorrhages in the long-term period after the operation, from 5 to 7 years.
Results. The minimum follow-up time was 60 and the maximum - 84 months. 84% of patients were interviewed. 20 (13,5%) patients died during the follow-up. Non-fatal complications (thrombosis and thromboembolism) were recorded in 39 (31.5%) of the patients. The frequency of non-fatal haemorrhages was 17.3%; and according to the types of prostheses used: "On-X" – 1 (2.6%) "Carbomedics" – 7 (17.9%), “MedIng” – 31 (79.5%), "ATS" – 0. Overall survival taking into account the valvular causes might be up to 85–90% in 7 years after surgery.
Conclusion. The results obtained make it possible to identify modifiable factors which open the perspectives for improving long-term outcomes. They are: preferable type of mechanical prosthesis; optimization and control of the anticoagulant therapy taking into account pharmacogenetic parameters, and at-home self-testing of the INR; development of the better schemes for anticoagulation.
Keywords:mitral valve diseases, mechanical prostheses, anticoagulants, thromboses, thromboembolism, hemorrhage
Clin Experiment Surg. Petrovsky J. 2018; 6 (3): 70–7.
doi: 10.24411/2308-1198-2018-13007. Received: 28.05.2018. Accepted: 10.08.2018.
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