Outcome of Noncardiac and Nonvascular Surgery in Patients With Mechanical Heart Valves.

Link to article at PubMed

Outcome of Noncardiac and Nonvascular Surgery in Patients With Mechanical Heart Valves.

Am J Cardiol. 2012 May 14;

Authors: Biteker M, Tekke?in AI, Can MM, Dayan A, Ilhan E, Türkmen FM

There is a tendency to avoid noncardiac surgery in patients with mechanical heart valves (MHVs) owing to the increased risk of perioperative thromboembolism, infective endocarditis, and bleeding. We aimed to determine the risk of cardiac and noncardiac complications in patients with MHVs who underwent noncardiothoracic, nonvascular surgery. A total of 140 patients with MHVs (77 aortic, 46 mitral, and 17 double valve) and 1,200 patients with native valves (control group) were prospectively followed up for a minimum of 3 months after noncardiothoracic and nonvascular surgery. Patients with bioprostheses were excluded. Those patients aged >18 years who underwent an elective, non-outpatient, open surgical procedure were enrolled. Subcutaneous enoxaparin 1 mg/kg, twice daily, was used as bridging anticoagulation. The demographics, co-morbidities, and preoperative (medications, echocardiographic findings, laboratory results) and postoperative data were evaluated for their association with the occurrence of perioperative adverse events. The incidence of perioperative adverse cardiovascular (10.8% vs 10.7%, p = 0.985) and noncardiovascular (11.9% vs 11.4%, p = 0.989) events was similar in those patients with and without MHVs. Bleeding (18.6% vs 14.2%, p = 0.989), thromboembolism (3.6% vs 2%, p = 0.989), and mortality at 3 months (1.4% vs 1.3%, p = 0.825) were also similar for the 2 groups. In conclusion, with close follow-up and strict adherence to the guidelines, patients with MHVs and patients with native heart valves undergoing noncardiac and nonvascular surgery have a similar risk of mortality and morbidity.

PMID: 22591673 [PubMed - as supplied by publisher]

One Comment

  1. This study looked at outcomes of patients with mechanical valves being “bridged” with enoxaparin. Despite practice guidelines supporting the use of enoxaparin for bridging (see http://bit.ly/enoxa), many institutions still rely on unfractionated heparin, prolonging length of stay.

    How do you “bridge” your mechanical valve patients for procedures?

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