Ann Short Rep | Volume 1, Issue 2 | Research Article | Open Access
Ujjwal K Chowdhury1*, Pranav Sharma1, Lakshmi Kumari Sankhyan1, Suruchi Hasija2, Rajeev Narang3 and Manikalaivani4
1Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, India
2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, India
3Department of Cardiology, All India Institute of Medical Sciences, India
4Department of Biostatistics, All India Institute of Medical Sciences, India
*Correspondance to: Ujjwal K Chowdhury
Fulltext PDFIntroduction: The purpose of this study was to investigate the thromboembolic and bleeding complications following St. Jude Medical (SJM) mechanical heart valve replacement, maintaining an optimal target International Normalized Ratio (INR) between 2.5 to 3.5 in a rheumatic population.
Methods: Data from 217 patients following mitral valve replacement (MVR; n=58), aortic valve replacement (AVR; n=68), and combined aortic and mitral valve replacements (DVR; n=91) with SJM valve between January 2013 and December 2017 were analyzed, covering a total follow-up period of 420.14 patient-years. All complications were registered prospectively.
Results: Fifty-two thromboembolic events were documented (DVR: n=22; MVR: n=15; AVR: n=15). Major bleeding events requiring hospitalization or transfusion occurred in 7 patients (AVR: n=1; MVR: n=2; DVR: n=4). Twenty-five (11.5%) patients had prosthetic heart valve thrombosis. Eighteen (72%) patients had successful treatment, 5 (20%) patients had partially successful treatment, and 2 (8%) patients had unsuccessful thrombolysis. Five (2.3%) patients required reoperation due to failed thrombolysis of stuck valve (MVR: n=3; Aortic valve of DVR group; n=2). Significant variability of INR values were observed in DVR and AVR groups (DVR: p=0.001; AVR: p=0.04) and accounted for higher mortality, thromboembolism and bleeding complications. The actuarial survival at 68 months was 70.7 ± 0.01% (MVR), 66.9 ± 0.1% (AVR) and 59.6% ± 0.22% (DVR).
Conclusion: We conclude that despite attempting to maintain a target INR, there exists a statistically significant wide variability of warfarin effect among patients undergoing combined aortic and mitral valve replacements and isolated AVR, thereby predisposing then to a greater risk of thromboembolic and bleeding complications.
Chowdhury UK, Sharma P, Sankhyan LK, Hasija S, Narang R, Manikalaivani. Thromboembolic and Bleeding Complications following St. JudeM Medical Valve Replacement. Ann Short Reports. 2018;1:1009.