Mechanical Aortic Valve Prosthesis Research Articles

Hemodynamic Comparison of the On-X and Top Hat Mechanical Aortic Valve Prostheses

BackgroundThere are limited data comparing hemodynamic valve function in mechanical aortic valve prostheses. This study compared the hemodynamic function of 2 commonly used mechanical aortic valve (AV) prostheses, the On-X (Artivion) and Top Hat (CarboMedics Inc) valves. MethodsThis study was a retrospective analysis of 512 patients who underwent AV replacement with the On-X (n = 252; 49%) or Top Hat (n = 260; 51%) mechanical valves between 2011 and 2019. Patients were matched on the basis of selected variables. Echocardiographic data were collected preoperatively and postoperatively over a median follow-up of 1.39 years. ResultsA total of 320 patients were matched, 160 patients in each group. Despite being matched for left ventricular outflow tract diameter, patients in the Top Hat group received a greater prevalence of smaller tissue annulus diameter valves (≤21 mm) (83% vs 38%; P < .001). Patients in the On-X group had longer aortic cross-clamp times (78 minutes vs 64 minutes; P < .001) during isolated aortic valve replacement. Discharge echocardiography showed no difference in the AV area index between both groups (1.00 cm2/m2 vs 1.02 cm2/m2; P = .377). During longer-term echocardiographic follow-up, the AV area index remained stable for both valves within their respective tissue annulus diameter groups (P = .060). ConclusionsThere was no difference between the 2 valves with respect to the AV area index at discharge, and hemodynamic function was stable during longer-term follow-up. The longer aortic cross-clamp time observed in the On-X group may indicate increased complexity of implantation compared with the Top Hat group.

Comparative Long-Term Clinical Performance of Mechanical Aortic Valve Prostheses

Aggregated data and long-term follow-up in national health data registers offer the opportunity to compare the performance of mechanical aortic prostheses within the same population. To investigate the clinical performance of mechanical aortic valve prostheses. This nationwide cohort study included all 5224 patients who underwent primary mechanical aortic valve replacement in Sweden between January 1, 2003, and December 31, 2018. Statistical analysis was performed between May and September 2023. Surgical aortic valve replacement with the On-X, Carbomedics, Bicarbon, Standard, Regent, Open Pivot, Masters, or Advantage valve models. The primary outcome was all-cause mortality, and secondary outcomes were reintervention, heart failure, major bleeding, stroke, and embolic events. Regression standardization was used to account for baseline differences. Overall, 5224 patients (mean [SD] age, 56.8 [11.7] years; 3908 men [74.8%]) were included. Total follow-up time was 43 982 person-years (mean [SD], 8.4 [4.6] years; maximum, 17.2 years). After regression standardization, there was a significant difference in 10-year mortality between the Carbomedics model group (17%; 95% CI, 15%-18%), Regent model group (17%; 95% CI, 13%-20%), and Standard model group (17%; 95% CI, 14%-19%) compared with the Bicarbon model group (27%; 95% CI, 21%-34%). In this cohort study of mechanical valve surgical aortic replacement outcomes in Sweden, the rate of all-cause mortality was higher in the Bicarbon group than in the Carbomedics, Regent, and Standard model groups. These findings warrant further research on the long-term clinical performance of the Bicarbon valve.

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry.

Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.

PB1546 Time is Everything: Case Report of an Acute Thrombosis of Mechanical Aortic Valve Prosthesis in a Pregnant Woman

PB1546 Time is Everything: Case Report of an Acute Thrombosis of Mechanical Aortic Valve Prosthesis in a Pregnant Woman

Acute Myocardial Infarction Due to Coronary Embolism in a Young Woman with Mechanical Aortic Valve Prosthesis and Anomalous Origin of Two Coronary Vessels: A Case Report

Acute Myocardial Infarction Due to Coronary Embolism in a Young Woman with Mechanical Aortic Valve Prosthesis and Anomalous Origin of Two Coronary Vessels: A Case Report

A Rare 10-Year Outcome Inverted Replacement of the Mitral Valve with a Mechanical Aortic Valve Prosthesis in an Achondroplastic Dwarfism

A Rare 10-Year Outcome Inverted Replacement of the Mitral Valve with a Mechanical Aortic Valve Prosthesis in an Achondroplastic Dwarfism

Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis.

Increased inflammatory biomarkers have been reported in prosthetic heart valve thrombosis (PHVT). Monocyte to HDL ratio (MHR) and albumin to CRP levels (CAR) are two biomarkers used widely for systemic inflammation but there is a lack of data on prosthetic heart valves. This study aimed to find out the potential predictive value of MHR and CAR for PHVT. Patients who had the diagnosis of mechanical mitral/aortic PHVT and normally functioning prosthesis were retrospectively analyzed. Laboratory data including complete blood count and biochemistry were recorded. Transesophageal echocardiography was performed to diagnose PHVT. The study included 118 patients with mechanical PHVT and 120 patients with normally functioning prosthesis. White blood count, monocyte levels, C-reactive protein, MHR and CAR were significantly higher whereas the lymphocyte, HDL and INR levels on admission were lower in patients with PHVT. Multivariate analysis showed that as well as inadequate anticoagulation, MHR, but not CAR, was found to be an independent predictor of thrombosis in patients with PHVT. Receiver operating characteristic curve analysis was performed to detect the best cut-off value of MHR in the prediction of thrombosis in patients with prosthetic valves. MHR level of > 12.8 measured on admission, yielded an AUC value of 0.791 [(CI 95% 0.733-0.848 p < 0.001) sensitivity 71%, specificity 70%]. Inadequate anticoagulation is the primary cause that leads to thrombosis in mechanical prosthetic valves. Increased MHR, but not CAR, was also shown to be an independent predictor of thrombosis in patients with mechanical mitral and aortic prosthetic valves.

A functioning Björk–Shiley aortic valve after 36 years without anticoagulation

There is a broad consensus among all clinical guidelines that lifelong oral anticoagulation is mandatory after mechanical valve prosthesis implantation. However, in rare cases, patients do not receive anticoagulation or anticoagulation therapy is withdrawn over time. We present a case of an exceptionally durable Björk-Shiley mechanical aortic valve prosthesis still functioning 49 years after implantation. Remarkably, the patient did not receive any anticoagulation or antiplatelet therapy for the first 36 years after implantation. Despite this, no thromboembolic or valve-related adverse events occurred to date. Upon thorough echocardiographic assessment, excellent valve function with a mean transvalvular gradient of 13 mmHg and no prosthetic valve insufficiency was found. This makes the case presented here one of the longest functioning mechanical valve replacements reported.

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom.

Surgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom. All patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50-59, 60-69, 70-79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed. The number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60-69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses. Surgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.

Completely detached mechanical aortic valve prosthesis stuck to the aortic arch in a patient with Behçet’s disease

BackgroundAlthough detachment of the implanted valve prosthesis was a well-known complication in patients with Behçet’s disease, complete detachment of an aortic bileaflet valve prosthesis has never been reported.Case presentationAn 18-year-old boy with Behçet’s disease (HLA-A26 positive) who had previously undergone aortic valve replacement with an 18-mm ATS-Advanced Performance (ATS-AP) valve (ATS Medical, Inc., Minneapolis, MN) at the age of 12 years, presented sudden-onset general fatigue and was emergently transferred to the regional hospital. Chest X-ray showed displacement of the implanted mechanical valve. An echocardiogram revealed mobile valve prosthesis and severe aortic regurgitation. Just before leaving for our hospital for surgical treatment, a completely detached valve prosthesis was floating in the ascending aorta. On arrival, the valve prosthesis was stuck to the transverse arch. Emergent removal of the previous mechanical valve from the aortic arch and redo aortic valve replacement with a 24-mm ATS-AP valve were performed under total circulatory arrest. Infectious endocarditis was denied by histopathological examination. The patient was back to the intensive care unit with extracorporeal membrane oxygenation support, which was successfully decannulated 5 days later.ConclusionsThis was the first report of a patient with Behçet’s disease who encountered a complete detachment of implanted aortic valve prosthesis. The patient could be rescued by emergent surgery.

Adherence to Anticoagulation Ambulatory during the Beginning of Coronavirus Pandemic

INTRODUCTION: Treatment with Vitamin K Antagonists is already proven to be significant in reducing thromboembolic events in patients with indications for systemic anticoagulation. In the context of ambulatory adherence, the SARS-CoV2 coronavirus pandemic emerged as a challenge for managing patients undergoing anticoagulation. &#x0D; &#x0D; METHODS: To avoid crowding and follow the recommended measures of social distancing, the Anticoagulation Ambulatory of the Hospital Universit&amp;aacute;rio de Santa Maria started to adopt a differentiated model of care, with a collection of hospital prothrombin time and immediate home return, followed by teleconsultation, with medication adjustment, as necessary. The present study aimed to assess adherence to the new care model, as well as the profile of patients seen. A retrospective cohort study was conducted, analyzing consultations between March and May 2020. &#x0D; &#x0D; RESULTS: The results demonstrate a low-educated population (76% had completed elementary school at most). The most common indications for the use of oral anticoagulation were atrial fibrillation (33.6%), followed by mechanical aortic valve prosthesis (31.3%) and mechanical mitral valve prosthesis (17.2%). Regarding adherence, especially to blood collection in the scheduled period, there was low adherence in the initial weeks of the pandemic declaration, with substantial improvement in adherence in the last two weeks of analysis. &#x0D; &#x0D; CONCLUSION: Determining the clinical characteristics and profile of patients helps to determine the local needs of this population and implement active search strategies to improve adherence rates, which may reduce unfavorable outcomes.

Mechanical aortic valve prostheses offer a survival benefit in 50-65year olds: AUTHEARTVISIT study.

BackgroundThe present population‐based cohort study investigated long‐term mortality after surgical aortic valve replacement (AVR) with bioprosthetic (B) or mechanical aortic valve prostheses (M) in a European social welfare state.MethodsWe analysed patient data from health insurance records covering 98% of the Austrian population between 2010 and 2018. Subsequent patient‐level record linkage with national health data provided patient characteristics and clinical outcomes. Further reoperation, myocardial infarction, heart failure and stroke were evaluated as secondary outcomes.ResultsA total of 13,993 patients were analysed and the following age groups were examined separately: <50 years (727 patients: 57.77% M, 42.23% B), 50–65 years (2612 patients: 26.88% M, 73.12% B) and >65 years (10,654 patients: 1.26% M, 98.74% B). Multivariable Cox regression revealed that the use of B‐AVR was significantly associated with higher mortality in patients aged 50–65 years compared to M‐AVR (HR = 1.676 [1.289–2.181], p < 0.001). B‐AVR also performed worse in a competing risk analysis regarding reoperation (HR = 3.483 [1.445–8.396], p = 0.005) and myocardial infarction (HR = 2.868 [1.255–6.555], p = 0.012). However, the risk of developing heart failure and stroke did not differ significantly after AVR in any age group.ConclusionsPatients aged 50–65 years who underwent M‐AVR had better long‐term survival, and a lower risk of reoperation and myocardial infarction. Even though anticoagulation is crucial in patients with M‐AVR, we did not observe significantly increased stroke rates in patients with M‐AVR. This evident survival benefit in recipients of mechanical aortic valve prostheses aged <65 years critically questions current guideline recommendations.

Direct transaortic transcather valve-in-valve implantation into a mechanical aortic valve prosthesis during left ventricular assist device implantation: description of a surgical technique.

The presence of a mechanical aortic valve prosthesis is considered a relative contraindication for left ventricular assist device implantation (LVAD) due to the occurrence of thromboembolic events. Five patients were operated on for LVAD implantation with status post mechanical aortic valve implantation (n = 3 with status post Bentall procedure). After removal of the leaflets, a transcatheter balloon-expandable valve was placed within the mechanical ring in all patients. Three patients were discharged from hospital with a maximum follow-up of 3.3 years. Transaortic transcatheter valve implantation into a mechanical aortic valve during LVAD implantation is a feasible option. It reduces operative times and might also prevent thromboembolic events.

Report on outcomes of valve-in-valve transcatheter aortic valve implantation and redo surgical aortic valve replacement in the Netherlands.

ObjectiveWe sought to investigate real-world outcomes of patients with degenerated biological aortic valve prostheses who had undergone valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or reoperative surgical aortic valve replacement (redo-SAVR) in the Netherlands.MethodsPatients who had undergone ViV-TAVI or redo-SAVR for a degenerated biological aortic valve prosthesis in the Netherlands between January 2014 and December 2018 were eligible for this retrospective study. Patients with a prior homograft, active endocarditis or mechanical aortic valve prosthesis were excluded. Patients were matched using the propensity score. The primary endpoint was a composite of 30-day all-cause mortality and in-hospital postoperative stroke. Secondary endpoints were all-cause mortality at different time points, in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year. Baseline characteristics and outcome data were collected from the Netherlands Heart Registration.ResultsFrom 16 cardiac centres, 653 patients were included in the study (374 ViV-TAVI and 279 redo-SAVR). European System for Cardiac Operative Risk Evaluation I (EuroSCORE I) was higher in ViV-TAVI patients (19.4, interquartile range (IQR) 13.3–27.9 vs 13.8, IQR 8.3–21.9, p < 0.01). After propensity score matching, 165 patients were matched with acceptable covariate balance. In the matched cohorts, the primary endpoint was not significantly different for ViV-TAVI and redo-SAVR patients (odds ratio 1.30, 95% confidence interval 0.57–3.02). Procedural, 30-day and 1‑year all-cause mortality rates, incidence of in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year were also similar between cohorts.ConclusionPatients with degenerated aortic bioprostheses treated with ViV-TAVI or redo-SAVR have similar mortality and morbidity.Supplementary InformationThe online version of this article (10.1007/s12471-021-01608-0) contains supplementary material, which is available to authorized users.

Mechanical Aortic Valve Prostheses Offer a Survival Benefit Over Bioprostheses Among 50 to 65-Year-Olds: The AUTHEARTVISIT Study

Background: The present study investigated long-term mortality after aortic valve replacement (AVR) with bioprosthetic (B) or mechanical aortic valve prostheses (M) in a European social welfare state. Methods: We analysed patient data from health insurance records covering 98% of the Austrian population between 2010 and 2018. Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcomes. Further reoperation, myocardial infarction, heart failure, and stroke were evaluated as secondary outcomes. Findings: A total of 13 993 patients were analysed and the following age groups were examined separately: 65 years (10 654 patients: 1·26% M, 98·74% B). Multivariable Cox regression revealed that the use of B-AVR was significantly associated with higher mortality in patients aged 50 – 65 years compared to M-AVR (HR = 1·676 [1·289 – 2·181], p < 0·001). B-AVR also performed worse in a competing risk analysis regarding reoperation (HR = 3·483 [1·445 – 8·396], p = 0·005) and myocardial infarction (HR = 2·868 [1·255 – 6·555], p = 0·012). However, the risk of developing heart failure and stroke did not differ significantly after B-AVR and M-AVR in any age group. Interpretation: Patients aged 50 – 65 years who undergo M-AVR had better long-term survival, and a lower risk of reoperation and myocardial infarction, compared to B-AVR. Even though anticoagulation is crucial in patients with M-AVR, we did not observe significantly increased stroke rates in patients with M-AVR. This evident survival benefit in recipients of mechanical aortic valve prostheses aged < 65 years critically questions current guideline recommendations. Clinical Trial Registration Details: The trial was registered at clinicaltrials.gov (NCT: NCT04900909). Funding Information: This work was supported by the institutional research laboratories ARGE Ankersmit (FOLAB Chirurgie). Declaration of Interests: All other authors report no competing interests. Ethics Approval Statement: This study was a nationwide, population-based cohort study and complied with the Declaration of Helsinki. It was approved by the ethics committee of lower Austria (EC number: GS1-EK-4/722-2021).

Bicuspid Aortic Valve in Infants, Children, and Adolescents: A Review for Primary Care Providers.

1. Talha Niaz, MBBS* 2. Jonathan N. Johnson, MD*,† 3. Frank Cetta, MD*,† 4. Timothy M. Olson, MD*,† 5. Donald J. Hagler, MD*,† 1. *Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and 2. †Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN * Abbreviations: AHA : : American Heart Association BAV : : bicuspid aortic valve TTE : : transthoracic echocardiography Bicuspid aortic valve is the most common congenital heart defect in children, adolescents, and adults. Primary care providers play an important role in screening, referral, and follow-up of these patients and should be aware of the family screening guidelines, sports participation recommendations, and periodic follow-up requirements for adequate surveillance of the complications that arise from bicuspid aortic valve. After reading this article, readers should be able to: 1. Describe the epidemiology and anatomy of bicuspid aortic valve (BAV). 2. Understand the clinical presentation and diagnosis of BAV in infants, children, and adolescents. 3. Identify the various complications of BAV disease. 4. Discuss the management and follow-up requirements for BAV. 5. Analyze the family screening and sports participation guidelines for patients with BAV. Bicuspid aortic valve (BAV) is the most common congenital heart defect in children, adolescents, and adults. (1) It is a heterogeneous disease that affects both the aortic valve and the aorta. It can lead to many complications, including aortic valve stenosis, regurgitation, or endocarditis. (2)(3) It also can lead to dilation of the aorta, predisposing individuals to a significantly higher risk of aortic aneurysm and dissection. (4) Although most individuals with BAV present with these long-term complications during adulthood, a considerable number of patients may also present during childhood and adolescence with early-onset disease; that may require interventions in up to 12% to 15% of the patients. (5)(6) Therefore, patients with BAV require lifelong follow-up and surveillance. BAV has multiple implications in terms of sports participation and family screening, making it an important subject for primary care providers. This article reviews the anatomy, genetics, presentation, diagnosis, …

Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

Minimally invasive redo aortic valve replacement with a sutureless valve implant.

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

Aortic valve replacement with biological prosthesis in patients aged 50-69 years.

There is no consensus regarding the use of biological or mechanical prostheses in patients 50-69 years of age. Previous studies have reported a survival advantage with mechanical valves. Our goal was to compare the long-term survival of patients in the intermediate age groups of 50-59 and 60-69 years receiving mechanical or biological aortic valve prostheses. We conducted a retrospective analysis of patients in the age groups 50-59 years (n = 329) and 60-69 years (n = 648) who had a first-time isolated aortic valve replacement between 2000 and 2019. Kaplan-Meier and competing risk analyses were performed to compare survival, incidence of aortic valve reoperation, haemorrhagic complications and thromboembolic events for mechanical versus biological prostheses. Patients aged 50-59 years with a biological prosthesis had a higher probability of aortic valve reintervention (26.3%, biological vs 2.6% mechanical; P < 0.001 at 15 years). The incidence of haemorrhagic complications or thromboembolic events was similar in the 2 groups. Patients aged 60-69 years with a mechanical prosthesis had a higher risk of haemorrhagic complications (6.9%, biological vs 16.2%, mechanical; P = 0.001 at 15 years). Biological prostheses had a higher overall probability of reintervention for valve dysfunction (20.9%, biological vs 4.8%, mechanical; P = 0.024). In both age groups, there was no difference in long-term survival between patients receiving a biological or a mechanical prosthesis. There was no difference in long-term survival between mechanical and biological prostheses for both age groups. Mechanical prostheses had a higher risk of bleeding in the 60-69-year group whereas biological valves had higher overall reintervention probability without an impact on long-term survival. It may be safe to use biological valves based on lifestyle choices for patients in the 50-69-year age group.

Safety of low intensity oral anticoagulant therapy in patients with bileaflet mechanical aortic valve prosthesis: A propensity weighted study

BackgroundScarce data are available on the long-term outcomes of different regimens of oral anticoagulation in an all comer population of patients undergoing aortic valve replacement with a bileaflet mechanical heart valve. MethodsOutcomes of 88 patients discharged with a target INR of 2.0 (LOW-INR) were compared to 147 contemporary patients who have been recommended a target INR of 2.5 (CONV). Primary outcome was the composite of any thromboembolic or haemorrhagic events. Secondary outcomes were the individual components of the primary outcome, cardiovascular mortality and stroke. To reduce selection bias, a propensity weighted analysis was performed. ResultsAfter inverse probability of treatment weighting, the primary endpoint occurred in 0.7% of patient in the LOW-INR group and in 7.0% in the CONV group (p = .0255). Linearized event rate were significantly lower in the LOW-INR group (primary endpoint: rate difference − 12.0 per 1000 patient/years, p = .0052; haemorrhage: −5.8 per 1000 patient/years, p = .0330; neurological events: −7.6 per 1000 patient/years, p = .0140). Conventional target INR was associated with an increased hazard of the composite endpoint (HR 11.193, 95% CI 1.424–88.003, p = .0217). ConclusionsLowering the intensity of oral anticoagulation resulted in a relevant clinical benefit of reduced rates of haemorrhagic and neurological adverse events in the mid-term follow-up. This report confirms the safety profile of the low INR regimen in an all comer population undergoing aortic valve replacement with an Abbott mechanical valve.