Remote Thromboembolic Complications after Mitral Valve Replacement
The aim of this research was to investigate remote thromboembolic complications after mitral valve replacement. Analy-sis group included 634 patients with isolated mitral valve disease who were on treatment at the National M.M. Amosov Institute of Cardiovascular Surgery from 1 January, 2005, till 1 January, 2007. The mean duration of the follow-up was 9.3 ± 0.9 years. The main parameters studied within 10 years were survival (69.4%), stability of good and satisfactory results (57.3%), freedom from thromboembolic complications (79.7%), freedom from reoperations (95.4%). The study included 299 (47.1%) men and 335 (52.9%) women. The mean age of the subjects was 53.1 ± 8.5 years. 89 (34.1%) patients were classified in class II by NYHA, 199 (31.7%) in class III and 380 (60.0%) in class IV. The most common etiology of the dis-order was rheumatism combined with lipoidosis and myxomatosis (67.5%). The mean duration of rheumatic disease was 17.3 ± 4.9 years. The mean duration of atrial fibrillation was 3.1 ± 0.9 years.
Mitral valve replacement (MVR) was carried out in all the subjects. The following types of bileaflet valve prostheses were used for mitral valve replacement: St. Jude, On-X, Carbomedics, Edwards MIRA. Based on the analysis, the risk factors of remote thromboembolic complications were revealed (type of the prosthesis, adequacy of anticoagulant therapy, occur-rence of prosthetic-dependent complications such as prosthetic endocarditis, panus or thrombosis of mitral valve prosthesis, increased left atrium size of more than 5.0 cm, contractility disorders). Mitral valve replacement is recommended for the patients of II–III class with sinus rhythm.
After the mitral valve replacement, patients (especially those at risk: patients with long-term atrial fibrillation, rheumatic heart disease, atriomegaly) need permanent clinical supervision by cardiologist at the place of residence. In order to prevent and reduce the risk of thromboembolic complications, concomitant procedures are obligatory during mitral valve replace-ment: ligation of left atrium appendage, Cox Maze procedure, left atrium plasty and anticoagulant therapy escalation using an antiplatelet agent.
- Lazoryshynets VV, Knyshov GV, Popov VV. [Treatment of mitral valve disease complicated by atrial fibrillation]. Kyiv; 2014. p.101. Russian.
- Orlov VI, Murzabekova LI. [Cardiac surgery for patients with acquired heart valvular disease: long-term results and clinical factors influencing them]. Russian Journal of Cardiology. 2005;55(5):87–94. Russian.
- OrlovskiiPI, Gritsenko VV, Vavilova TV, Kadinskaia MI, Petrishina TI, Mochalov OIu, et al. [Two approaches to correction of disturbed hemostasis in patients with mechanical artificial heart valves at the long-term follow-up]. Vestn Khir Im I I Grek. 2004;163(5):20–4. Russian.
- American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists, Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease. J Am Coll Cardiol. 2006;48(3):e1–148. https://doi.org/10.1016/j.jacc.2006.05.021
- Avitall B, Kalinski A. Cryotherapy of cardiac arrhythmia: from basic science to the bedside. Heart Rhythm. 2015;12:2195–203. https://doi.org/10.1016/j.hrthm.2015.05.034
- Butchart EG, Payne N, Li HH, Buchan K, Mandana K, Grunkemeier GL. Better anticoagulation control improves survival after valve replacement. J Thorac Cardiovasc Surg. 2002;123:715–23.
- Damiano RJ Jr, Badhwar V, Acker MA, Veeragandham RS, Kress DC, Robertson JO, Sundt TM. The CURE-AF trial: a prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery. Heart Rhythm. 2014;11:39–45. https://doi.org/10.1016/j.hrthm.2013.10.004
- January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of the patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1–76. https://doi.org/10.1016/j.jacc.2014.03.022
- La Meir M. Surgical options for treatment of atrial fibrillation. Ann Cardiothorac Surg. 2014;3:30–7. https://doi.org/10.3978/j.issn.2225-319X.2014.01.07
- Masoudi FA, Calkins H, Kavinsky CJ, Slotwiner DJ, Turi ZG, Drozda JP Jr, et al. 2015 ACC/HRS/SCAI left atrial appendage occlusion device societal overview: a pro-
- fessional societal overview from the American College of Cardiology, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2015;86:791–807. https://doi.org/10.1002/ccd.26170
- Prabhu S, McLellan AJ, Walters TE, Sharma M, Voskoboinik A, Kistler PM. Atrial structure and function and its implications for current and emerging treatments for atrial fibrillation. Prog Cardiovasc Dis. 2015;58:152–67. https://doi.org/10.1016/j.pcad.2015.08.004
- Stefanidis C, Nana AM, De Canniиre D, Antoine M, Jansens JL, Huynh CH, Le Clerc JL. 10-Year Experience With the ATS Mechanical Valve in the Mitral Position. Ann Thorac Surg. 2005;79:1934–8. https://doi.org/10.1016/j.athoracsur.2005.01.002