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mechanical aortic valve anticoagulation elderly

Domenico Acanfora, Chiara Acanfora, Pietro Scicchitano, Marialaura Longobardi, Giuseppe Furgi, Gerardo Casucci, Bernardo Lanzillo, Ilaria Dentamaro, Annapaola Zito, Raffaele Antonelli Incalzi, Marco Matteo Ciccone
BACKGROUND AND OBJECTIVES: The new oral anticoagulants (NOACs) are used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and those at risk of deep venous thrombosis. Their rapid onset of action and predictable pharmacokinetic and pharmacodynamic profiles make them the optimal alternative to warfarin in the treatment of these two categories of patients. Unfortunately, however, NOACs cannot be used in patients with valvular AF or valvular cardiac prostheses...
October 2016: Clinical Drug Investigation
Shiv Kumar Choudhary, Sachin Talwar, Balram Airan
Mechanical prostheses and stented xenografts (bioprosthesis) are most commonly used substitutes for aortic and mitral valve replacement. The mechanical valves have the advantage of durability but are accompanied with the risk of thromboembolism, problems of long-term anticoagulation, and associated risk of bleeding. In contrast, bioprosthetic valves do not require long-term anticoagulation, but carry the risk of structural valve degeneration and re-operation. A mechanical valve is favoured in young patients (<40 years) if reliable anticoagulation is ensured...
2016: Heart Asia
Roberto Adriano Latini, Luca Testa, Nedy Brambilla, Maurizio Tusa, Francesco Bedogni
In the last years, a general shift toward the use of surgical bioprosthetic aortic valves rather than mechanical valves with subsequent less use of anticoagulant therapy has been observed. However, bioprosthetic valves have limited durability. Reoperation, the current standard of care for these patients, carries a high surgical risk, especially because patients are elderly and with numerous comorbidities. Recently, transcatheter aortic valve replacement within a failed bioprosthetic valve (valve-in-valve procedure) has proven feasible...
April 2016: Giornale Italiano di Cardiologia
A Halapas, M Chrissoheris, Konstantinos Spargias
Bioprosthetic heart valves are often preferred over mechanical valves as they may preclude the need for anticoagulation. Reoperation is the standard treatment for structural failure of bioprosthetic valves; however, it carries significant risk especially in inoperable elderly patients. Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) seems to be an effective and promising procedure in patients with degenerated bioprosthetic aortic valves avoiding the risks associated with the use of cardioplegia and redo cardiac surgery...
August 2014: Journal of Invasive Cardiology
Guido J Van Nooten, Thierry Bové, Yves Van Belleghem, Katrien François, Frank Caes, Guy Vandenplas, Michel De Pauw, Yves Taeymans
BACKGROUND: Since May 1992 the Medtronic Open Pivot mechanical heart valve has been implanted routinely at the authors' institution. The study aim was to analyze, retrospectively, the 20-year clinical results of the valve. METHODS: Between May 1992 and December 2011 a total of 1,520 valves was inserted into 1,382 consecutive patients (1,012 aortic, 473 mitral, 26 tricuspid, 9 pulmonary). The mean age of the patients was 61±13.2 years. Preoperatively, 65% of the patients were in New York Heart Association (NYHA) class III or greater...
April 2014: Annals of Thoracic Surgery
Yuki Okamoto, Kazuo Yamamoto, Tsutomu Sugimoto, Takashi Wakabayashi, Kaori Kato, Sinya Mimura, Shinpei Yoshii
We carried out a retrospective evaluation of the early and mid-term outcomes of aortic valve replacement (AVR) for aortic stenosis in hemodialysis patients. Between 2004 and 2012, a total of 40 dialysis patients underwent AVR with or without an additional procedure. Hemodialysis was performed routinely the day before and during the operation. At surgery, decalcification was performed using a cavitron ultrasonic surgical aspirator(CUSA) and a high performance mechanical valve was then implanted, with the exception of elderly patients or those in whom use of oral anticoagulation is contraindicated...
September 2013: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Josep Rodés-Cabau, Harold L Dauerman, Mauricio G Cohen, Roxana Mehran, Eric M Small, Susan S Smyth, Marco A Costa, Jessica L Mega, Michelle L O'Donoghue, E Magnus Ohman, Richard C Becker
Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events remains largely unknown...
December 24, 2013: Journal of the American College of Cardiology
Vinayak Bapat, Izanne Mydin, Sucharitha Chadalavada, Hassan Tehrani, Rizwan Attia, Martyn Thomas
Surgical aortic valve replacement remains the therapy of choice in majority of patients with aortic stenosis. Bioprosthetic heart valves are often preferred over mechanical valves as they preclude the need for anticoagulation with its associated risks of bleeding and thromboembolism. However, bioprosthetic heart valves undergo structural deterioration and eventually fail. Reoperation is the standard treatment for structural failure of the bioprosthetic valve, stenosis or regurgitation but can carry a significant risk, especially in elderly patients with multiple comorbidities...
April 2013: Catheterization and Cardiovascular Interventions
Yutaka Kobayashi, Yasunori Fukushima, Takahiro Hayase, Kazushi Kojima, George Endo
BACKGROUND: Various surgical techniques have been proposed to treat small aortic annulus. We have used small-diameter mechanical valves for small aortic annulus. The present study examined aortic valve replacement with small diameter mechanical valves to determine their effectiveness. METHODS: The study included 67 patients who underwent elective, isolated aortic valve replacement with ATS-Advanced Performance (AP) valves (ATS Medical, Inc, Minneapolis, MN) within our department...
April 2010: Annals of Thoracic Surgery
Laura Beth Nugteren, Kristin E Sandau
BACKGROUND: While studies of health-related quality of life (HRQOL) are increasing among cardiovascular patients, very few have examined HRQOL in persons with aortic stenosis (AS). PURPOSE: A critical review of studies (1997-2008) of HRQOL in persons with AS was conducted to summarize findings and identify clinical and research implications. RESULTS: Twenty-eight studies were identified, all of which were quantitative and evaluated HRQOL after aortic valve replacement (AVR)...
January 2010: Journal of Cardiovascular Nursing
Yoshitsugu Nakamura, Kiyoharu Nakano, Osamu Tagusari, Go Kataoka, Yoshimasa Seike, Satoru Domoto, Yujiro Ito
BACKGROUND AND AIM OF THE STUDY: The optimal procedure and prosthesis remains debatable for aortic valve replacement (AVR) in high-risk elderly patients in whom the aortic annulus is too small to allow a standard AVR procedure with even the smallest sized bioprosthetic valve available. Herein are reported the early and mid-term results of standard AVR using a 16 mm ATS Advanced Performance (AP) mechanical heart valve. METHODS: The medical records of 10 patients (mean age 75 +/- 5 years; range: 64-79 years) in whom 16 mm ATS AP valves had been implanted in the supra-annular position were reviewed retrospectively...
November 2009: Journal of Heart Valve Disease
Leo A Bockeria, Ivan I Skopin, Renat M Muratov, Irina E Olofinskaya
No abstract text is available yet for this article.
October 2009: Interactive Cardiovascular and Thoracic Surgery
Rafet Gunay
No abstract text is available yet for this article.
October 2009: Interactive Cardiovascular and Thoracic Surgery
Gonçalo F Coutinho, Rita Pancas, Pedro E Antunes, Manuel J Antunes
We propose to analyse the long-term follow-up in patients older than 65 years of age who received a mechanical valve in the aortic position, using death and prosthetic-related complications as endpoints. From April 1988 to December 1995, 144 consecutive patients 65-75 years of age (mean 67.7+/-2.5) were enrolled. Total duration of follow-up was 1663 patient-years (median 13.0 years) and was complete for 99% of the patients. Thirty-day mortality was 1.4% (n=2). At the end of the study, 77 patients (53.8%) were alive, with ages ranging from 77 to 91 years (mean 82...
October 2009: Interactive Cardiovascular and Thoracic Surgery
Kevin D Accola, Meredith L Scott, George J Palmer, Paul A Thompson, Mark E Sand, Jorge E Suarez-Cavalier, Jeffrey N Bott, George Ebra
BACKGROUND AND AIM OF THE STUDY: Aortic valve dysfunction is the most common form of valvular heart disease. As the population continues to age, a greater number of patients will become candidates for aortic valve replacement (AVR); hence, prosthetic valve choice becomes of paramount importance. METHODS: A retrospective analysis was conducted on 801 patients aged > or =65 years who underwent isolated AVR or AVR + coronary artery bypass grafting (CABG) between January 1989 and June 2003 with a Carpentier Edwards Perimount (CEP) pericardial bioprosthesis (n = 398) or a St...
July 2008: Journal of Heart Valve Disease
Mariano Vicchio, Alessandro Della Corte, Luca Salvatore De Santo, Marisa De Feo, Giuseppe Caianiello, Michelangelo Scardone, Maurizio Cotrufo
BACKGROUND: The aim of this study was to determine whether changes in prognosis and quality of life (QOL) after aortic valve replacement (AVR) in octogenarians differ depending on the choice of mechanical (MP) or tissue (BP) valves. METHODS: Between July 1992 and September 2006, 160 consecutive octogenarians underwent AVR with (18.8%) or without concomitant coronary artery bypass grafting. At follow-up (mean 3.4 +/- 2.8 years, 552 patient-years, 98.3% complete), 121 were still alive and answered the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) QOL questionnaire...
April 2008: Annals of Thoracic Surgery
Mariano Vicchio, Alessandro Della Corte, Marisa De Feo, Giuseppe Santarpino, Luca S De Santo, Gianpaolo Romano, Giuseppe Caianiello, Michelangelo Scardone, Maurizio Cotrufo
BACKGROUND: The aim of the study was to examine our experience with the implant of bileaflet mechanical prostheses and with a centralized management of anticoagulation and the related risks in patients aged older than 70 years, focusing on the resulting expectancy and quality of life. METHODS: Between January 1988 and January 2005, 681 consecutive patients older than 70 years (mean age, 73 +/- 3.3 years) underwent bileaflet prostheses implantation in an isolated procedure (77%) or concomitant with other procedures (23%)...
August 2007: Annals of Thoracic Surgery
Hirotaka Inaba, Kazuhiko Higuchi, Kenji Koseni, Hiroshi Ohsawa, Osamu Kinoshita, Katsuyasu Funatogawa, Minoru Matsumoto
PURPOSE: Some investigators suggest that hemodynamic outcomes may be superior with the stentless aortic bioprosthesis when compared with a mechanical valve. The goal of this study was to characterize outcomes and hemodynamic data associated with each type of valve. SUBJECTS AND METHODS: Patient outcomes and echocardiographic data were compared between 25 patients with stentless valves and 59 patients with mechanical valves. RESULTS: There were no significant differences in survival and freedom from cardiovascular adverse events between two groups...
June 2007: Annals of Thoracic and Cardiovascular Surgery
Andrea Colli, Jean-Philippe Verhoye, Alain Leguerrier, Tiziano Gherli
Improvements in the performance and longevity of biological valve prostheses have steadily increased their rates of implantation in recent years. Aortic bioprostheses, which are commonly used in the elderly or when the risks of anticoagulating are high, have generally been associated with low rates of long-term complications. Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described, a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement has not been developed...
April 2007: European Journal of Cardio-thoracic Surgery
Justin Nowell, Emma Wilton, Hugh Markus, Marjan Jahangiri
The life expectancy of the general population is increasing. This has meant that more elderly patients are requiring aortic valve replacement (AVR). The choice of valve replacement and its durability are important. Bioprosthetic (tissue) heart valves were introduced into clinical use in the 1960s and were developed primarily to reduce the complications associated with thromboembolism (TE) and the need for lifelong oral anticoagulation, due to their low thrombogenicity compared to mechanical prostheses. This makes them suitable for use in elderly patients (aged>65 years) and in others where the risks of anticoagulation are higher or anticoagulation is contraindicated...
April 2007: European Journal of Cardio-thoracic Surgery
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