Comparison over short term of mortality and morbidity of mechanical and bioprosthetic heart valves in the Indian population

Abstract

Background Choice of heart valve in the developing countries is an unsettled issue due to illiteracy and noncompliance related increase in incidences of stuck valve and anticoagulant related bleeding and as such international guidelines may not be wholly applicable. The aim of our study was to compare outcomes after mitral, aortic or double valve replacements with mechanical versus bioprosthetic valves. Methods Data of 503 patients who underwent cardiac valve replacement [300 mitral, 125 aortic, and 78 double valve] with either mechanical [bileaflet valve, n=257] or biological [Hancock II, n=246] valve from January 2003 to December 2008, were retrospectively analyzed. Specific outcomes assessed included incidences of valve thrombosis, systemic thromboembolism, anticoagulant related bleeding, structural valve dysfunction, prosthetic valve endocarditis, reoperation and death.Results Both the groups were comparable preoperatively except that patients receiving biological valve were more likely to be female and belonging to a rural setup. 30 day mortality was comparable in both groups. Incidences of valve related complications were significantly commoner in mechanical valve group. Two patients with mechanical valve required reoperation for stuck prosthetic valve at about 3 years after primary operation. There were two deaths in mechanical valve group, both related to stuck prosthetic valve. Prosthetic valve endocarditis was not reported in either group. At 5 years there was no incidence of structural valve dysfunction. Conclusions Mechanical valves are associated with a significantly higher complication rate compared with biological valves in Indian patients. Biological valves thus maybe specifically suited to the Indian scenario. However, in choosing a prosthetic valve, patients' involvement and informed consent should take the utmost importance.

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

“…The target INR was 2.0-3.0 in MVR or AVR, and 2.5-3.5 in DVR. The study concluded that mechanical valves have significantly higher complication rate than bioprosthesis valves in Indian patients [64].…”

“…In a study on Indian patients with MVR, the incidences of bleeding complication are common in patients with a mechanical valve (6%) than those with a bioprosthetic valve (0.9%) [61]. Evidence suggests that fresh frozen plasma (FFP) and packed red cell transfusion are used as antithrombotic therapies for the management of bleeding incidences in prosthetic valves patients in India [41,61,64].…”