Portal de Periódicos da CAPES

A Comparison of Mechanical Valve Performance in a Poorly Anticoagulated Community

2004; Wiley; Volume: 19; Issue: 5 Linguagem: Inglês

10.1111/j.0886-0440.2004.04084.x

1540-8191

M.A. Williams, Lisa A. Crause, Sonia van Riet,

Cardiac Valve Diseases and Treatments

Journal of Cardiac SurgeryVolume 19, Issue 5 p. 410-414 A Comparison of Mechanical Valve Performance in a Poorly Anticoagulated Community M.A. Williams F.R.C.S. (Ed), M.A. Williams F.R.C.S. (Ed) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this authorL. Crause F.C.S. (S.A.), L. Crause F.C.S. (S.A.) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this authorS. Van Riet M.B.C.H.B. (UOFS), S. Van Riet M.B.C.H.B. (UOFS) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this author M.A. Williams F.R.C.S. (Ed), M.A. Williams F.R.C.S. (Ed) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this authorL. Crause F.C.S. (S.A.), L. Crause F.C.S. (S.A.) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this authorS. Van Riet M.B.C.H.B. (UOFS), S. Van Riet M.B.C.H.B. (UOFS) Department of Cardiothoracic Surgery, Provincial Hospital, Port Elizabeth, Republic of South AfricaSearch for more papers by this author First published: 17 September 2004 https://doi.org/10.1111/j.0886-0440.2004.04084.xCitations: 13 Address for correspondence: Dr. M.A. Williams, 314 Greenacres Hospital, Greenacres, 6045 Port Elizabeth, South Africa. Fax: +41-3633401. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Abstract Background: This study was undertaken to evaluate the clinical performance of the Carbomedics, Medtronic Hall and On-X valves in the challenging setting of a Third World population with incomplete anticoagulation coverage. Methods: In the Carbomedics group 140 valves were implanted in 126 patients (aortic 30, mitral 82, and aortic and mitral 14), 39% were adequately anticoagulated. Follow-up was 89% complete for a total of 216 patient-years. In the Medtronic Hall series 224 valves were implanted in 198 patients (aortic 50, mitral 122, and aortic and mitral 26), 39% were adequately anticoagulated. Follow-up was 93% complete for a total of 459 patient-years. In the On-X series 252 valves were implanted in 200 patients (aortic 44, mitral 104, and aortic and mitral 52), 58% were adequately anticoagulated. Follow-up was 94% complete for a total of 2217 patient-years. Results: Hospital mortality was 2.4% (3 patients) in the Carbomedics group, 3.9% (9 patients) in the Medtronic Hall group, and 2.0% in the On-X group. None of the hospital deaths were valve-related. The linearized rates for late complications in the mitral position (percent per patient-year) were, respectively, for the Carbomedics (CM), the Medtronic Hall (MH), and On-X valves—thromboembolism: 1.4 (CM), 1.1 (M.H.); 0.0 (On-X); bleeding: 0.0 (CM), 0.4 (MH); 0.0 (On-X); thrombosis: 6.5 (CM), 2.0 (MH); 0.0 (On-X). In the aortic position, the linearized rates of late complications were, respectively—thromboembolism: 0.0 (CM), 1.6 (MH); 2.2 (On-X); bleeding: 1.3 (CM), 1.0 (MH); 0.0 (On-X); thrombosis: 1.3 (CM), 0.0 (MH); 0.0 (On-X). Conclusions: There were no significant differences in the performance of the three valves in the aortic position. In the mitral position the linearized rate of valve thrombosis was significantly higher in the Carbomedics group (p = 0.002). REFERENCES 1 Edmunds LH, Clark RE, Cohn LH, et al: Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg 1988; 46: 257- 259. 2 Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Statist Assoc 1958; 53: 457- 481. 3 Cox DR: Regression models and life tables. J R Statist Soc 1972; 148: 82- 117. 4 Copeland JG, Sethi GK: Four-year experience with the Carbomedics valve: The North American experience. Ann Thorac Surg 1994; 58: 630- 638. 5 De Luca D, Vitale N, Giannolo B, et al: Mid term follow up after heart valve replacement with Carbomedics bileaflet prostheses. J Thorac Cardiovasc Surg 1993; 106: 1158- 1165. 6 Fiane A, Saatvedt K, Svennevig J, et al: The Carbomedics valve: Midterm follow up with analysis of risk factors. Ann Thorac Surg 1995; 60; 1053- 1058.DOI: 10.1016/0003-4975(95)00637-Z 7 Reddy N, Padmanabhan T, Singh S, et al: Thrombolysis in left sided prosthetic valve occlusion: Immediate and follow up results. Ann Thorac Surg 1994; 58: 462- 471. 8 Wang S, Chu S, Tsai C, et al: Clinical use of Carbomedics and St Jude Medical valves. Artif Organs 1996; 20: 1299- 1303. Citing Literature Volume19, Issue5September 2004Pages 410-414 ReferencesRelatedInformation