Mitral Valve Replacement With A One Calibre Fits All Mechanical Prosthesis: The Value Of Minimally Invasive Oral Anticoagulation
Gabriele Di Giammarco, MD, Michele Di Mauro, MD, Daniele Marinelli, MD, Massimiliano Foschi, MD, Tariq Mobariki, MD, Donato Micucci, MD, Flavia Armato, MD.
Department of Cardiac Surgery, University “G.D’Annunzio” Chieti-Pescara, Chieti, Italy.
OBJECTIVE: Retrospective evaluation of the results of mitral valve replacement using a full pyrolitic carbon supra-anular valve with one size (outer diameter of valve 25mm, cuff diameter 33) which can fit any diameter of native mitral annulus. The design and the materials confer to the prosthesis a low risk of thromboembolic events and this is the reason of the allowed low range of anticoagulation regimen.
METHODS: Between April 2002 and April 2014 the prosthesis was implanted in 126 patients. Echocardiographic and clinical follow-up was performed in order to analyse the performance of the prosthesis and the clinical events focused on thromboembolic and haemorrhagic events.
RESULTS: Mean age was 62,97 ± 9,114), 53 males and 73 females (respectively 42% and 58%). Isolated mitral valve replacement was performed in 48 patients (38%). Additional procedures were performed in 78 patients (62%). Mean follow-up was 76,968 months (maximum 144 and minimum 10). Early mortality (<30 days) was 7,9% (10 patients), and late mortality (> 30 days) was 17% (20/116 patients). Adverse events were as follows: 1 case (0,9%; 0,1%patient-year) of heart transplantation after 41 mouths, 1 case (0,9%; 0,1%patient-year) of reoperation for paravalvular leak after 86 months, 7 patients (6%; 0,9%patient-year) with heart failure symptoms and 2 cases experienced stroke (1,7 %; 0,3%patient-year); there were no bleeding events. Echocardiography was performed in 96 patients, EF was 60%±8, EDV 118ml±35, ESV 50ml±21, LA area 20cm2±11, CW velocity 163cm/s±28, peak gradient 11mmHg±3, mean gradient 5mmHg±2, EOA(BSA 1,1cm2/m2±0,3, PPM (EOA/BSA<0.75) 2 (2%), leakage 2 ( 2%) mild, and sPAP 35mmHg±10.
CONCLUSIONS: In our experience the use of this full pyrolitic mitral valve prosthesis provide good long term clinical and echocardiographic results with a low rate of thromboembolic or hemorrhagic events.
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