Recommendations for the management of patients after heart valve surgery

Abstract

Approximately 50,000 valve replacement operations take place in Europe annually and almost as many valve repair procedures. Previous European guidelines on management of patients after valve surgery were last published in 1995 and were limited to recommendations about antithrombotic prophylaxis. American guidelines covering the broader topic of the investigation and treatment of patients with valve disease were published in 1998 but devoted relatively little space to post-surgical management. This document represents the consensus view of a committee drawn from three European Society of Cardiology (ESC) Working Groups (WG): the WG on Valvular Heart Disease, the WG on Thrombosis, and the WG on Rehabilitation and Exercise Physiology. In almost all areas of patient management after valve surgery, randomized trials and meta-analyses do not exist. Such randomized trials as do exist are very few in number, are narrowly focused with small numbers, have limited general applicability, and do not lend themselves to meta-analysis because of widely divergent methodologies and different patient characteristics. Recommendations are therefore almost entirely based on non-randomized studies and relevant basic science.

Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

“…13 While high-visibility studies 14 suggested that TEs were exceptional with optimal anticoagulation, TEs remain a major problem after mechanical MVR, 6 and their link to anticoagulation quality remains controversial. 7,10,14 -19 Many studies 3,7,9,10,18,20,21 have analyzed convenience samples of mechanical MVR, but incomplete or sparse anticoagulation data have been usual.…”

“…22 Hence, clinical guidelines 2,13,22-24 acknowledge scant evidence supporting anticoagulation recommendations and are remarkably discrepant (European vs American guidelines) regarding the thrombogenicity of mechanical prostheses and the tailoring of the goals of anticoagulation to patient and prosthesis. 2,13,22,23 Therefore, we sought to evaluate the factors associated with TEs in patients who have undergone mechanical MVR in the population (not referral practice) with a complete record of all TEs and of the entire anticoagulation profile. We aimed at analyzing the link between TEs and the anticoagulation achieved and the prosthesis type.…”

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

“…Recent recommendations advocate substituting warfarin after 35 weeks, because of the risk for intracranial haemorrhage of the child during delivery. 8,14 If there is no major bleeding after delivery, unfractionated heparin needs to be restarted four to six hours after delivery and oral anticoagulation can be given after 24 hours (target INR 2.5 to 3.5 in high-risk patients and 2.0 to 3.0 in low-risk patients.…”

“…14 Monitoring lysis of the valve thrombosis with TEE is recommended to detect increasing and obstructing thrombi. 14 When patients present with severe heart failure, there is a need for emergent valve replacement. 15,16 When surgery is not available or no longer an option, thrombolysis should be considered.…”

Rotation of disk aortic prosthesis due to its dysfunction as an alternative to re-replacement in cardiac surgery

“…Он также может служить причиной дисфункции кла-панного протеза, возникновения парапротезных фистул, а также быть источником опасных эмболий, что в боль-шинстве случаев требует хирургического лечения с репро-тезированием клапана [6,7].…”