Medtronic Hall valve replacement in a third-world population group

Antunes, Manuel J.; Wessels, Andre; Sadowski, R; Schütz, J; Vanderdonck, K.; Oliveira, José; Fernandes, Luis E.

doi:10.1016/s0022-5223(19)35663-6

Cited by 56 publications

(6 citation statements)

References 37 publications

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“…The Medtronic-Hall valve was always classified among the least thrombogenic of all mechanical valves [Vahanian 2012]. In fact, it was shown to have a low incidence of thrombosis and thromboembolism in a less compliant third-world population [Antunes 1988;Kinsley 1983]. Not only did it have low rates of thromboembolism and endocarditis, but it also achieved excellent outcomes with survival and freedom from reoperation, compared to the valves of its era and of contemporary valves still in use today [Butchart 2001;Svennevig 2007;Butchart 1988;Williams 2004].…”

Section: Discussionmentioning

confidence: 99%

To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

Joseph

2019

HSF

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The Achilles heel of mechanical valves appears to be the need for anticoagulation. Several different types of mechanical valves have come and gone. The success or lack thereof of these valves depended on their various designs. We compared the two most promising mechanical valves of different eras and the need for anticoagulation through a case review. Both the Medtronic-Hall tilting disc valve and the bileaflet On-X valve were compared and contrasted in terms of durability and management of anticoagulation in high-risk patient populations. We present two cases of challenging anticoagulation management: a patient who underwent a mitral valve replacement with a Medtronic-Hall tilting disc valve who was off anticoagulation for close to six years, and a patient who underwent On-X mitral and aortic valve replacements and suffered a subsequent intracranial bleed requiring surgical intervention. We explore the ethical dilemmas associated with these patients and the risk of restarting anticoagulation for each.

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Section: Discussionmentioning

confidence: 99%

To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

Joseph

2019

HSF

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“…While surgical patients who participated in studies during the 1960s and 1970s were largely in their late twenties and early thirties [ 111 ], today’s patients come to surgery in their forties to early fifties in the urban populations of threshold countries (mostly upper middle-income countries) [ 112 ]. With two thirds of mitral patients over the age of forty showing degrees of leaflet thickening and rigidity [ 113 ], the repairable group is limited to a minority of the patients and even with sophisticated surgical techniques have high re-operation rates [ 114 ].…”

Section: Current Epidemiology Of Gas Arf and Rhd Around The Worldmentioning

confidence: 99%

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Zühlke

Beaton

Engel

et al. 2017

Curr Treat Options Cardio Med

127

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Opinion statementEarly recognition of group A streptococcal pharyngitis and appropriate management with benzathine penicillin using local clinical prediction rules together with validated rapi-strep testing when available should be incorporated in primary health care. A directed approach to the differential diagnosis of acute rheumatic fever now includes the concept of low-risk versus medium-to-high risk populations. Initiation of secondary prophylaxis and the establishment of early medium to long-term care plans is a key aspect of the management of ARF. It is a requirement to identify high-risk individuals with RHD such as those with heart failure, pregnant women, and those with severe disease and multiple valve involvement. As penicillin is the mainstay of primary and secondary prevention, further research into penicillin supply chains, alternate preparations and modes of delivery is required.

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“…Mechanical prostheses are prone to thromboembolic complications, the incidence of which is magnified several fold by the poor adherence to anticoagulation protocols. 2 On the other hand, bioprostheses, which do not require anticoagulation, especially in young patients mostly in sinus rhythm, hence initially considered ideal for these populations, degenerate fast, sometimes within only a few years after implantation. 3 …”

Section: Introductionmentioning

confidence: 99%

Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservation

Antunes

2015

Global Cardiology Science and Practice

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In developing countries, rheumatic fever and carditis still constitutes a major public health problem. Patients have special characteristics that differ from those with rheumatic mitral valve disease we still see in developed countries. They are usually young, poor, uneducated, and have low compliance to prophylaxis / therapy. In addition, they usually have great difficulty in accessing medical care. In these situations, the rate of complications associated to valve replacement is significantly increased. Alternatively, mitral valve repair is now known to achieve better long-term results in this pathology, but this was not widely recognized three or four decades ago, when first reports showed worse results after repair of rheumatic regurgitation than with degenerative valves. This has been reported by several groups in developing countries in different continents, with high incidence of repairs and excellent long term results. It is, therefore, becoming increasingly clear that, although, the results may not compare to those obtained with degenerative pathology, repair of rheumatic valves, when feasible, is the procedure of choice, especially in these underprivileged populations.

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Medtronic Hall valve replacement in a third-world population group

Cited by 56 publications

References 37 publications

To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservation

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