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Poli, Daniela; Antonucci, Emilia; Pengo, Vittorio; Grifoni, Elisa; Maggini, Niccolò; Testa, Sophie; Lodigiani, Corrado; Insana, Antonio; Marongiu, Francesco; Barcellona, Doris; Paparo, Carmelo; Bucherini, Eugenio; Pignatelli, Pasquale; Palareti, Gualtiero

Risk of reoperation in bioprosthetic valve patients with indication for long-term anticoagulation. Results from the observational retrospective multicentre PLECTRUM study

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  • Media type: E-Article
  • Title: Risk of reoperation in bioprosthetic valve patients with indication for long-term anticoagulation. Results from the observational retrospective multicentre PLECTRUM study
  • Contributor: Poli, Daniela; Antonucci, Emilia; Pengo, Vittorio; Grifoni, Elisa; Maggini, Niccolò; Testa, Sophie; Lodigiani, Corrado; Insana, Antonio; Marongiu, Francesco; Barcellona, Doris; Paparo, Carmelo; Bucherini, Eugenio; Pignatelli, Pasquale; Palareti, Gualtiero
  • imprint: BMJ, 2018
  • Published in: Open Heart
  • Language: English
  • DOI: 10.1136/openhrt-2018-000837
  • ISSN: 2053-3624
  • Keywords: Cardiology and Cardiovascular Medicine
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Objective</jats:title><jats:p>Several factors should be considered when a prosthetic heart valve, bioprosthetic valve (BV) or mechanical valve is to be implanted: thrombogenicity, life expectancy and the risk of reoperation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted an observational retrospective multicentre study among Italian Thrombosis Centers on patients with BV on long-term vitamin K antagonist (VKA) treatment to evaluate the risk of reoperation and the rate of bleeding and thrombotic events.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We analysed 612 patients (median age 71.8 years) with BV on long-term VKA treatment for the presence of atrial fibrillation (AF) (78.4%) or other indications (21.6%). Thirty-four major bleeding events (rate 1.1×100 patient-years) and 29 thromboembolic events (rate 0.9×100 patient-years) were recorded, and 46 patients (rate 1.5×100 patient-years) underwent reoperation. The rate of reoperation was higher among younger patients: 32.9% in patients &lt;60 years and 3.9% in patients ≥60 years (relative risk (RR) 3.8, 95% CI 2.1 to 7.2; p=0.0001). When patients were analysed according to age &lt;65 or ≥65 years and &lt;75 or ≥70 years, younger patients still were at higher risk for reoperation (RR 3.1, 95% CI 1.7 to 6.0 and 3.7, 95% CI 1.7 to 8.6, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings suggest that the threshold of 65 years for implanting a BV should be carefully evaluated, considering the high risk for reoperation and the high risk of AF occurrence with persisting need for long-term anticoagulation. The high risk for reoperation of young patients implanted with BV and the availability of a safer and easier way to conduct VKA treatment, such as the use of point-of-care devices, should be considered when the type of valve must be chosen.</jats:p></jats:sec>
  • Access State: Open Access