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Mitral valve repair and bioprosthetic replacement without postoperative anticoagulation does not increase the risk of stroke or mortality

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dc.contributor.author Schwann T.A.
dc.contributor.author Engoren M.
dc.contributor.author Bonnell M.
dc.contributor.author Clancy C.
dc.contributor.author Khouri S.
dc.contributor.author Kabour A.
dc.contributor.author Jamil T.
dc.contributor.author Habi R.H.
dc.contributor.editor
dc.date Jul-2013
dc.date.accessioned 2017-10-05T15:41:49Z
dc.date.available 2017-10-05T15:41:49Z
dc.date.issued 2013
dc.identifier 10.1093/ejcts/ezs626
dc.identifier.isbn
dc.identifier.issn 10107940
dc.identifier.uri http://hdl.handle.net/10938/18211
dc.description.abstract Objectives: The study aimed to determine if mitral valve repair (MVRR) or bioprosthetic mitral valve replacement (BMVR) without postoperative anticoagulation is associated with a similar risk of thromboembolism and death as anticoagulation. Methods: We retrospectively reviewed our 2004-09 experience in 249 MVRR and bioprosthetic replacement patients (53percent female; 63 year mean age). Concurrent procedures principally included antiarrhythmic surgery, aortic valve replacement, tricuspid valve repair and coronary bypass grafting. Warfarin therapy was instituted at the discretion of the surgeon. Thirty-day, a period known to have the highest risk of valve-related thromboembolism, outcomes were compared relying on the incidence of stroke and death as surrogates of thromboembolic complications. Intermediate-term survival was compared between the groups using Cox proportional hazard models. The mean follow-up was 2.9 years. Given the non-randomized warfarin use, a propensity score using patient comorbidities and concurrent procedures was created and added to the Cox models. Results: One hundred and ninety-two (77percent) patients were discharged on warfarin and 57 (23percent) were discharged without warfarin. Thirty-day mortality in patients discharged from the index hospitalization was 1.2percent and was similar for the two groups (P = 0.99). Four ischaemic perioperative strokes were detected; 3 in the warfarin group and 1 in the no warfarin group (P = 0.99). Overall survival was 84percent, with 84percent survival in the warfarin group and 86percent in the no warfarin group (P = 0.79). Bleeding complications were comparable between the two groups (P = 0.72). In a multivariate analysis, warfarin was not related to mortality. Conclusions: Despite current guidelines recommending postoperative anticoagulation following MVRR or bioprosthetic replacement, the avoidance of warfarin does not increase perioperative complications and has no impact on intermediate survival. Accordingly, a prospective randomized study to adjudicate the role of extended warfarin thromboprophylaxis in mitral valve surgery is warranted. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
dc.format.extent
dc.format.extent Pages: (24-31)
dc.language English
dc.publisher CARY
dc.relation.ispartof Publication Name: European Journal of Cardio-thoracic Surgery; Publication Year: 2013; Volume: 44; no. 1; Pages: (24-31);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title Mitral valve repair and bioprosthetic replacement without postoperative anticoagulation does not increase the risk of stroke or mortality
dc.type Article
dc.contributor.affiliation Schwann, T.A., Department of Surgery, University of Toledo College of Medicine, Toledo, OH, United States
dc.contributor.affiliation Engoren, M., Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States, Mercy Saint Vincent Medical Center, Toledo, OH, United States
dc.contributor.affiliation Bonnell, M., Department of Surgery, University of Toledo College of Medicine, Toledo, OH, United States
dc.contributor.affiliation Clancy, C., Department of Surgery, University of Toledo College of Medicine, Toledo, OH, United States
dc.contributor.affiliation Khouri, S., Department of Surgery, University of Toledo College of Medicine, Toledo, OH, United States
dc.contributor.affiliation Kabour, A., Mercy Saint Vincent Medical Center, Toledo, OH, United States
dc.contributor.affiliation Jamil, T., Department of Surgery, University of Toledo College of Medicine, Toledo, OH, United States
dc.contributor.affiliation Habi, R.H., Outcomes Research Unit, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
dc.contributor.authorAddress Schwann, T.A.; Department of Surgery, University of Toledo College of Medicine, Mail Stop 1095, 3000 Arlington Ave., Toledo, OH 43614, United States; email: thomas.schwann@utoledo.edu
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision
dc.contributor.authorEmail thomas.schwann@utoledo.edu
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Schwann, TA
dc.contributor.authorInitials Engoren, M
dc.contributor.authorInitials Bonnell, M
dc.contributor.authorInitials Clancy, C
dc.contributor.authorInitials Khouri, S
dc.contributor.authorInitials Kabour, A
dc.contributor.authorInitials Jamil, T
dc.contributor.authorInitials Habib, RH
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Schwann, TA (reprint author), Univ Toledo, Dept Surg, Coll Med, Mail Stop 1095,3000 Arlington Ave, Toledo, OH 43614 USA.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.cited Akins CW, 2008, EUR J CARDIO-THORAC, V33, P523, DOI 10.1016-j.ejcts.2007.12.055; Alfieri O, 2001, J THORAC CARDIOV SUR, V122, P674, DOI 10.1067-mtc.2001.117277; Aramendi JL, 1998, J HEART VALVE DIS, V7, P610; Asopa Sanjay, 2006, Interact Cardiovasc Thorac Surg, V5, P761, DOI 10.1510-icvts.2006.143099; Bonow Robert O, 2008, Circulation, V118, pe523, DOI 10.1161-CIRCULATIONAHA.108.190748; Budnitz Daniel S, 2011, N Engl J Med, V365, P2002, DOI 10.1056-NEJMsa1103053; Butchart EG, 2005, EUR HEART J, V26, P2463, DOI 10.1093-eurheartj-ehi426; CARPENTIER A, 1980, J THORAC CARDIOV SUR, V79, P338; Colli A, 2010, J HEART VALVE DIS, V19, P405; EBERLEIN U, 1990, EUR J CARDIO-THORAC, V4, P605, DOI 10.1016-1010-7940(90)90020-Z; EDMUNDS LH, 1987, ANN THORAC SURG, V44, P430; EDMUNDS LH, 1988, ANN THORAC SURG, V46, P257; Geerts WH, 2008, CHEST, V133, p381S, DOI 10.1378-chest.08-0656; Gherli T, 2004, CIRCULATION, V110, P496, DOI 10.1161-01.CIR.0000137122.95108.52; HERAS M, 1995, J AM COLL CARDIOL, V25, P1111, DOI 10.1016-0735-1097(94)00563-6; HORSTKOTTE D, 1998, J THROMB THROMBOLYS, V5, pS19; Horstkotte D, 1995, J Heart Valve Dis, V4, P114; LAWRIE GM, 2012, 48 SOC THORAC SUG AN; NUNEZ L, 1984, ANN THORAC SURG, V37, P84; NUNEZ L, 1982, ANN THORAC SURG, V33, P354; Ruel M, 2004, ANN THORAC SURG, V78, P77, DOI 10.1016-j.athorascur.2003.12.058; Russo A, 2008, J AM COLL CARDIOL, V51, P1203, DOI 10.1016-j.jacc.2007.10.058; Salem DN, 2008, CHEST, V133, p593S, DOI 10.1378-chest.08-0724; Vahanian A, 2007, EUR HEART J, V28, P230, DOI 10.1093-eurheartj-ehl428; Vaughan P, 2005, J HEART VALVE DIS, V14, P576
dc.description.citedCount 2
dc.description.citedTotWOSCount 0
dc.description.citedWOSCount 0
dc.format.extentCount 8
dc.identifier.articleNo ezs626
dc.identifier.coden EJCSE
dc.identifier.pubmedID 23293318
dc.identifier.scopusID 84878222878
dc.identifier.url
dc.publisher.address JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA
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dc.relation.ispartofConferenceCode
dc.relation.ispartofConferenceDate
dc.relation.ispartofConferenceHosting
dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
dc.relation.ispartofFundingAgency
dc.relation.ispartOfISOAbbr Eur. J. Cardio-Thorac. Surg.
dc.relation.ispartOfIssue 1
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle European Journal of Cardio-thoracic Surgery
dc.relation.ispartofPubTitleAbbr Eur. J. Cardio-thorac. Surg.
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 44
dc.source.ID WOS:000321826700020
dc.type.publication Journal
dc.subject.otherAuthKeyword Mitral valve replacement
dc.subject.otherAuthKeyword Repair without anticoagulation
dc.subject.otherChemCAS warfarin, 129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2
dc.subject.otherChemCAS Anticoagulants
dc.subject.otherChemCAS Warfarin, 5Q7ZVV76EI
dc.subject.otherIndex warfarin
dc.subject.otherIndex adult
dc.subject.otherIndex anticoagulant therapy
dc.subject.otherIndex aorta valve replacement
dc.subject.otherIndex article
dc.subject.otherIndex cardiovascular mortality
dc.subject.otherIndex cerebrovascular accident
dc.subject.otherIndex controlled study
dc.subject.otherIndex coronary artery bypass graft
dc.subject.otherIndex female
dc.subject.otherIndex human
dc.subject.otherIndex major clinical study
dc.subject.otherIndex male
dc.subject.otherIndex medical record review
dc.subject.otherIndex mitral valve repair
dc.subject.otherIndex postoperative hemorrhage
dc.subject.otherIndex priority journal
dc.subject.otherIndex prosthesiology
dc.subject.otherIndex retrospective study
dc.subject.otherIndex thromboembolism
dc.subject.otherIndex tricuspid valve repair
dc.subject.otherIndex Mitral valve replacement
dc.subject.otherIndex Repair without anticoagulation
dc.subject.otherIndex Aged
dc.subject.otherIndex Anticoagulants
dc.subject.otherIndex Bioprosthesis
dc.subject.otherIndex Female
dc.subject.otherIndex Heart Valve Prosthesis
dc.subject.otherIndex Heart Valve Prosthesis Implantation
dc.subject.otherIndex Humans
dc.subject.otherIndex Kaplan-Meier Estimate
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Mitral Valve
dc.subject.otherIndex Postoperative Complications
dc.subject.otherIndex Postoperative Period
dc.subject.otherIndex Proportional Hazards Models
dc.subject.otherIndex Statistics, Nonparametric
dc.subject.otherIndex Stroke
dc.subject.otherIndex Warfarin
dc.subject.otherKeywordPlus BLEEDING COMPLICATIONS
dc.subject.otherKeywordPlus PORCINE BIOPROSTHESIS
dc.subject.otherKeywordPlus HEART-DISEASE
dc.subject.otherKeywordPlus THROMBOEMBOLISM
dc.subject.otherKeywordPlus PREVENTION
dc.subject.otherKeywordPlus GUIDELINES
dc.subject.otherKeywordPlus ASPIRIN
dc.subject.otherKeywordPlus MANAGEMENT
dc.subject.otherKeywordPlus MORBIDITY
dc.subject.otherKeywordPlus SURGERY
dc.subject.otherWOS Cardiac and Cardiovascular Systems
dc.subject.otherWOS Respiratory System
dc.subject.otherWOS Surgery


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