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19.04.2017 | Original Article | Ausgabe 8/2017

General Thoracic and Cardiovascular Surgery 8/2017

10-year results of On-X bileaflet mechanical heart valve in the aortic position: low target INR regimen in Japanese

Zeitschrift:
General Thoracic and Cardiovascular Surgery > Ausgabe 8/2017
Autoren:
Hideki Teshima, Masahiko Ikebuchi, Yosuke Miyamoto, Ryuta Tai, Toshikazu Sano, Yusuke Kinugasa, Hiroyuki Irie

Abstract

Objectives

This study was designed to establish clinical outcomes after aortic valve replacement (AVR) with On-X bileaflet mechanical heart valve.

Methods

Between 2006 and 2014, AVR was performed to 686 patients. Of them, 78 patients using On-X valve were enrolled. The mean age was 65 ± 11 years (ranged 33–85); 65% were men; and 81% were in sinus rhythm preoperatively. Calcific or degenerative tricuspid aortic valve was present in 73%. Concomitant procedures included coronary artery bypass grafting (22%), Bentall (8%), mitral valve procedure (3%) and other (9%). They postoperatively received lower dose warfarin [international normalized ratio (INR), 1.5–2.0] and 100 mg aspirin daily. The follow-up duration averaged 5 years (386.6 patient-years). The follow-up rate was 97.3%.

Results

In-hospital mortality rates were 3.8% (n = 3). Late mortality rates were 2.6% per patient-years (n = 10). Five-year Kaplan–Meier survival rates were 84%. Freedom from major adverse valve-related stroke and cerebral bleeding events was 93.3% (n = 5, 1.29% per patient-years) and 98.6% (n = 1, 0.26% per patient-years, mild subdural hematoma). The incidence of stroke was two patients of transient ischemic attack, two patients of paralytic event, one patient of asymptomatic stroke (self-interruption of anticoagulation). The median INR was 1.92 ± 0.53, ranged from 1.00 to 8.98 (n = 1181) and 51% of all measured INR values were in the therapeutic range of 1.5–2.0.

Conclusions

AVR using On-X valve with low target INR regimen and low-dose aspirin resulted in a significantly low risk of bleeding.

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