The beneficial effect of anticoagulation in aortic bioprosthesis is associated with its size
Rev. bras. cir. cardiovasc
; 35(3): 307-313, May-June 2020. tab, graf
Artigo
em Inglês
| LILACS, Sec. Est. Saúde SP
| ID: biblio-1137277
Biblioteca responsável:
BR1.1
ABSTRACT
Abstract Objective:
To evaluate the clinical and echocardiographic outcomes in aortic valve replacement (AVR) patients with aortic bioprosthesis under oral anticoagulation (OA).Methods:
Patients who underwent AVR with bioprosthesiswere prospectively enrolled. They were classified based on postoperative use of OA. Clinical and operative variables were collected. Echocardiographic and clinical follow-ups were performed two years after surgery. The primary outcome evaluated was change in transprosthetic gradient. Secondary outcomes analyzed were change in New York Heart Association (NYHA) class, major bleeding episodes, hospitalization, stroke, and transient ischemic attack.Results:
We included 103 patients (61 without OA and 42 with OA). Clinical characteristics were similar among groups, except for younger age (76±6.3 vs. 72.4±8.1 years, P=0.016) and higher prevalence of atrial fibrillation (0% vs. 23.8%, P<0.001) in the OA group. Mean (21.4±10 mmHg vs. 16.8±7.7 mmHg, P=0.037) and maximum (33.4±13.7 mmHg vs. 28.4±10.2 mmHg, P=0.05) transprosthetic gradients were higher in patients without OA. Improvement in NYHA class was more frequent in patients with OA (73% vs. 45.3%, P=0.032). Major bleeding, stroke, and hospitalization were similar among groups. OA was the only independent predictor for improvement of NYHA class after multivariate logistic regression analysis (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2-29.4; P=0.028). Stratification by prosthesis size showed that patients with ≤ 21 mm prosthesis benefited from OA.Conclusion:
Early anticoagulation after AVR with bioprosthesis was associated with significant decrease of transprosthesis gradient and improvement in NYHA class. These associations were seen mainly in patients with ≤ 21 mm prosthesis.
Texto completo:
Disponível
Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
LILACS
/
Sec. Est. Saúde SP
Assunto principal:
Estenose da Valva Aórtica
/
Bioprótese
/
Próteses Valvulares Cardíacas
/
Implante de Prótese de Valva Cardíaca
Tipo de estudo:
Estudo prognóstico
/
Fatores de risco
Limite:
Idoso
/
Idoso, 80 anos ou mais
/
Humanos
Idioma:
Inglês
Revista:
Rev. bras. cir. cardiovasc
Ano de publicação:
2020
Tipo de documento:
Artigo
Instituição/País de afiliação:
Instituto Nacional de Cirugía Cardíaca/UY