Thirty-year outcomes of low-intensity anticoagulation for mechanical aortic valve.

The long-term safety, efficacy, and outcomes of low-intensity anticoagulation for mechanical heart valves remain unclear. This study aimed to evaluate the long-term outcomes of low-intensity anticoagulation therapy after aortic valve replacement (AVR) with a mechanical prosthesis. This retrospective cohort study consulted medical records and conducted a questionnaire to investigate 519 patients who underwent single AVR with the St. Jude Medical bileaflet valve and were in sinus rhythm. All patients were followed up with an international normalized ratio (INR) target of 1.6-2.5, and their INR values were checked throughout the follow-up period. The survival rate, incidence of major adverse cardiac and cerebrovascular events (MACCE), and risk factors for cardiac death and MACCE were investigated. The total follow-up was 9793 patient-years, and the follow-up periods were 19.9 (standard deviation [SD]: 7.9) years. The mean INR was 2.03 (SD: 0.54). Survival rates from cardiac death were 93.6% in 20 years and 85.2% in 30 years. Advanced age ≥ 70 years was the only significant risk factor for cardiac death and MACCE, and the INR < 2.0 was not significant risk factor for MACCE including thromboembolism or bleeding events. Low-intensity anticoagulation with an INR of 1.6-2.5 for patients with sinus rhythm after AVR with a bileaflet mechanical valve is safe and effective, even over 30 years.

[Aortic Remodeling in Uncomplicated Stanford Type B Aortic Dissection Stratified by The Timing of Thoracic Endovascular Aortic Repair:A Retrospective Cohort Study].

PURPOSE: We investigated the relationship between aortic remodeling and timing of thoracic endovascular aortic repair( TEVAR) in patients with uncomplicated Stanford type B aortic dissection. METHODS: 29 patients with sub-acute and early chronic uncomplicated Stanford type B aortic dissection underwent TEVAR between February 2019 and August 2022 in our hospital. We retrospectively compared aortic remodeling between 19 patients in the sub-acute( SA) group( 15-90 days from onset) and 10 patients in the early chronic( ECh) group( 91-365 days from onset) using the false luminal area reduction rate using computed tomography imagings. RESULTS: The false lumen area reduction rates at the level of the carina in the SA and ECh groups were 21.9±13.5% and 7.0±21.2% (p=0.04) around 3-8 days after TEVAR, 91.8±13.8% and 62.6±48.4 % (p=0.26) at 6 months, 96.6±7.2% and 68.7±42.5% (p=0.14) at 12 months, and 96.2±10.0% and 79.2±37.6% (p=0.62) at 18 months respectively. There were no significant differences between the two groups regarding any complication. CONCLUSION: Preemptive TEVAR for sub-acute and early chronic uncomplicated Stanford type B aortic dissection resulted in good remodeling and it may provide a good prognosis, especially in the subacute stage.

[Suspected Left Ventricular Pseudo-false Aneurysm of a Huge Size Combined with Sustained Ventricular Tachycardia;Report of a Case].

A 74-year-old man was transferred to our hospital for heart failure and ventricular tachycardia. Left ventricular aneurysm of a huge size( 6×9 cm) was found on the imaging test, and was suspected to be a pseudo-false aneurysm because of its thick wall with small orifice. Occulusion of the right coronary artery (#1) was revealed by coronary arteriography and the diskinetic aneurysm in the inferior wall was revealed by left ventriculography. The surgical treatment was needed, because of the high risk of rupture. He successfully underwent Dor operation with endocardial cryoablation and left ventricular ejection fraction (LVEF) was found to be improved by postoperative left ventriculography. He discharged on 56 days after operation. Ventricular pseudo-false aneurysm is rare and the treatment is controversial.