Prosthetic valve dysfunction in patients with mechanical heart valves: Results from the Emergency Salam Centre cohort
Nicoletta Erba a) b), Alberto Tosetto c), Suha Abdelwahab Abdallah a) b), Martin Langer a) b), Elena Giovanella a) b), Salvatore Lentini a) b), Franco Masini a) b), Alessandro Mocini a b), Gennarina Portella a) b), Alessandro Cristian Salvati a) b), Alessandro Squizzato d), Sophie Testa e), Daniela Poli f)
a) Medical Division, Emergency, ONG Onlus, Milan, Italy
b) Salam Centre for Cardiac Surgery, Khartoum, Sudan
c) Hematology Department, San Bortolo Hospital, Vicenza, Italy
d) Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
e) Hemostasis and Thrombosis Center, Laboratory Medicine Department, ASST Cremona, Cremona, Italy
f) Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Abstract
Introduction
Mechanical heart valve (MHV) replacement requires long-life anticoagulation due to the risk of Prosthetic Valve Dysfunction (PVD) and cardioembolism.
Methods
We report data from a prospective observational study conducted on MHV patients in the Khartoum Salam Centre for Cardiac Surgery built by ‘Emergency,’ an Italian Non-Governmental Organization, to evaluate the occurrence of PVD and associated risk factors.
Results
We prospectively followed 3647 patients, and 38 patients (rate 1.04 × 100 pt-years) had PVD during follow-up. The time in therapeutic range (TTR) among patients without PVD was 53 % (IQR 37–67), and it was 43 % (IQR 19–58) among patients with PVD (p = 0.04). Twenty-three over 38 patients (60.5 %) were symptomatic, 18 (47.4 %) had obstructive valvular stenosis, 24 patients (63.2 %) had INR <2.0 at diagnosis, and 21 patients (55.3 %) had been off warfarin for a long time: 3 patients for 1 week, 1 patient for 2 weeks, and 17 patients for >4 weeks (6 patients were off warfarin from 3 to 12 months). Ten were uncompliant to treatment, and 8 were pregnant women. Ten patients (26.3 %) with PVD had had a previous episode of PVD, and 14 patients (36.8 %) had 2 or more associated risk factors. Only in 6 cases were no associate risk factors found.
Conclusions
Among MHV patients on warfarin treatment with a sub-optimal quality of anticoagulation, the rate of PVD is 1.04 % pt-years, and the most frequent associated risk factor for PVD occurrence is warfarin withdrawal lasting more than one week.
Graphical abstract
