Thromboembolism in patients with pericardial valves in the absence of chronic anticoagulation: 12 years' experience

Abstract

Between January 1977 and January 1989, 465 pericardial bioprostheses were implanted in 424 patients. The mean age of patients was 59.1 years (range 16-81 y.) At the time of surgery, 68% of the patients suffered from chronic atrial fibrillation. Mitral valve replacement was performed in 167 patients, aortic valve replacement in 216, multiple replacement in 40 (36 mitral and aortic, 3 mitral and tricuspid, and 1 mitral, aortic and tricuspid), and 1 pulmonary valve replacement. The different types of pericardial valve used were: Ionescu-Shiley 408, Mitral Medical 23, Bioflo 30, and Hancock 4. Hospital mortality was 10.1% with an attrition rate of 1.8 episodes per 100 patients/year. The 12-year actuarial survival rate was 65.1%. No patient underwent long-term anticoagulant treatment. The first 144 patients undergoing mitral and multiple valve replacements received temporary anticoagulation for the first 8 weeks after surgery. There was no valve thrombosis observed. Altogether 19 thromboembolic events (6 early and 13 late) were clinically documented. One patient died after an embolic event. The linearized rates of thromboembolism were 1.64 episodes per 100 patients/year for mitral and multiple valve replacements and 0.33 episodes per 100 patients/year for aortic valve replacement, with an overall rate of 1.0 episodes per 100 patients/year. Excluding early thromboembolism, the linearized rate was 1.02 episodes per 100 patients/year overall. The actuarial freedom from embolism was 92.4% overall, 88.2% for the mitral and multiple valve replacement group, and 97.6% for the aortic valve replacement group at a maximum follow-up of 12 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Fine Structure of Glycosaminoglycans from Fresh and Decellularized Porcine Cardiac Valves and Pericardium

“…Noteworthy, the oversulfation level found here is comparable to that of DS from marine ascidians (50–70%) also studied for its thrombin inhibitory activity [37]. All that could be the rationale behind the still unexplained low thrombogenicity potential of pericardial valve xenografts making the chronic anticoagulation treatment unnecessary in such patients [38]. Moreover, this finding is in good agreement with published data which described the presence of a low-molecular-weight dermatan sulfate proteoglycan in bovine pericardial tissue [39].…”

Doppler Echocardiographic Comparison of Small (19 mm) Bileaflet and Pericardial Heart Valve Prostheses in Aortic Position

“…The results of the present and other studies (4,5,16,26) suggest that for 19 mm pericardial bioprostheses in aortic position, mounting of the pericardium outside the support frame is haemodynamically somewhat more satisfactory than the inside mounting used in the Carpentier-Edwards valve (although we know of no study with rigorous approach to this question in a large patient sample, and the precise clinical implications of the difference are unclear).…”

Textura de bioprótese mitral, função ventricular esquerda e formação de trombo: análise por ecocardiografia transesofágica e aplicação de bioescore

“…Edmunds et al 43 showed that there was a need for anticoagulation in 40 to 60% of the patients with biological prosthesis in mitral position; the incidence of thromoembolic episodes is greater in the first three months of bioprosthesis implant, the atrial fibrillation increases the risk of thromboembolic complications, the role of the presence of atrial thrombi, the size of left atrium and the history of previous embolic events is not clear yet in the increase of incidence of thromboembolic events. The atrial fibrillation is the main factor identified in the literature as responsible for the increase of risk of systemic thromboembolism in patients with mitral valvopathy [44][45][46][47] . Reports in the literature show a lower incidence of thromboembolic events in patients with bovine pericardium or dura mater bioprostheses in comparison with porcine biosprostheses [48][49][50] .…”