Thromboembolism in patients with pericardial valves in the absence of chronic anticoagulation: 12 years' experience

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Abstract
Between January 1977 and January 1989, 465 pericardial bioprostheseswere implanted in 424 patients. The mean age of patients was 59.1 years(range 16-81 y.) At the time of surgery, 68% of the patients suffered fromchronic atrial fibrillation. Mitral valve replacement was performed in 167patients, aortic valve replacement in 216, multiple replacement in 40 (36mitral and aortic, 3 mitral and tricuspid, and 1 mitral, aortic andtricuspid), and 1 pulmonary valve replacement. The different types ofpericardial valve used were: Ionescu-Shiley 408, Mitral Medical 23, Bioflo30, and Hancock 4. Hospital mortality was 10.1% with an attrition rate of1.8 episodes per 100 patients/year. The 12-year actuarial survival rate was65.1%. No patient underwent long- term anticoagulant treatment. The first144 patients undergoing mitral and multiple valve replacements receivedtemporary anticoagulation for the first 8 weeks after surgery. There was novalve thrombosis observed. Altogether 19 thromboembolic events (6 early and13 late) were clinically documented. One patient died after an embolicevent. The linearized rates of thromboembolism were 1.64 episodes per 100patients/year for mitral and multiple valve replacements and 0.33 episodesper 100 patients/year for aortic valve replacement, with an overall rate of1.0 episodes per 100 patients/year. Excluding early thromboembolism, thelinearized rate was 1.02 episodes per 100 patients/year overall. Theactuarial freedom from embolism was 92.4% overall, 88.2% for the mitral andmultiple valve replacement group, and 97.6% for the aortic valvereplacement group at a maximum follow-up of 12 years.(ABSTRACT TRUNCATED AT250 WORDS)

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