Abstract
The incidence of thrombotic and thromboembolic (TE) complications after Hancock valve replacement was reviewed in 140 patients with mitral valve prostheses and 150 patients with aortic valve prostheses. In patients with aortic valves, 1 embolus occurred and another patient was found at autopsy to have thrombi on a degenerated valve. Both patients had been on aspirin treatment. There was no TE event in patients receiving no anticoagulant therapy.
In patients with mitral valves, 16 showed pre- and/or postoperative low output syndrome (Group A); 8 of these patients died and 6 had autopsies that showed major thrombi in the heterograft. In 126 long-term survivors, 9 thromboembolic events occurred (TE incidence 5.4% per patient year). All patients with emboli had atrial fibrillation. The majority (7/9) of emboli occurred during the first 3 postoperative months. Five occurred in patients who were not on anticoagulation (Group B), and 2 occurred in patients receiving warfarin therapy (Group C). There was no thromboembolic event in patients receiving aspirin treatment (Group D).
It is concluded that patients with Hancock aortic valves have a very small risk of TE, and do not need anticoagulation. Patients with Hancock mitral valves with stable hemodynamics have a decreased risk of TE and do not require anticoagulation. Patients with atrial fibrillation have an increased risk of TE and should be on warfarin for 3 months after surgery and then on aspirin therapy.
Résumé
Nous avons revu la fréquence des thromboses et des thrombo-embolies (TE) après remplacement valvulaire par valve de Hancock, chez 140 patients porteurs d'une prothèse mitrale et 150 avec prothèse aortique. Chez les malades avec valve aortique, nous avons observé un embol et, à l'autopsie d'un autre cas, une thrombose sur une valve dégénérée. Les 2 malades avaient reçu de l'aspirine. Il n'y a pas eu de TE chez les patients ne recevant pas d'anticoagulants. Parmi les patients avec valve mitrale, 16 avaient, avant et/ou après l'opération, un syndrome de débit bas (groupe A): 8 sont décédés, dont 6 avaient, à l'autopsie, des thrombi importants sur l'hétérogreffe. Parmi 126 survivants à long terme, 9 accidents thrombo-emboliques ont été observés (fréquence: 5.4% par patient/année). Tous les malades qui ont fait une embolie avaient une fibrillation auriculaire. La majorité des embolies (7/9) sont survenues dans les 3 mois post-opératoires, dont 5 chez les malades ne recevant pas d'anticoagulants (groupe B) et 2 chez les patients sous warfarine (groupe C). Il n'y a pas eu d'accident thrombo-embolique chez les malades recevant de l'aspirine (groupe D).
On peut donc conclure que les malades porteurs d'une valve aortique de Hancock ont un risque de TE très faible; ils n'ont pas besoin d'anticoagulation. Chez las malades porteurs d'une valve mitrale de Hancock, stables au point de vue hémodynamique, le risque de TE est réduit; l'anticoagulation n'est pas nécessaire. Chez les malades avec fibrillation auriculaire, le risque de TE est accru: ces patients doivent être mis sous warfarine pendant les 3 premiers mois post-opératoires, puis sous aspirine.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gerbode, R., editor: Proceedings of the First International Workshop on Tissue Valves, October 1969. Ann. Surg.172[Suppl. 1]:1, 1970
Ross, J.K., Johnson, D.C.: Mitral valve replacement with homograft fascia lata and prosthetic valves: a long-term assessment of valve function. J. Cardiovasc. Surg.15:242, 1974
Barnhorst, D.A., Oxman, H.A., Connolly, D.C., Pluth, J.R., Danielson, G.K., Wallace, R.B., McGoon, D.C.: Long-term follow-up of the isolated replacement of the aortic or mitral valve with the Starr-Edwards prosthesis. Am. J. Cardiol.35:228, 1975
Bonchek, L.I., Starr, A.: Ball valve prostheses: current appraisal of the late results. Am. J. Cardiol.35:843, 1975
Kerth, W.J., Sharma, G., Hill, J.D., Gerbode, F.: A comparison of the late results of replacement and of reconstructive procedures for acquired mitral valve disease. J. Thorac. Cardiovasc. Surg.61:14, 1971
Messmer, B.J., Okies, J.E., Hallman, G.L., Cooley, D.A.: Early and late thromboembolic complications after mitral valve replacement—A comparative study of various prostheses. J. Cardiovasc. Surg.13:281, 1972
Brawley, R.K., Donahoo, J.S., Gott, V.L.: Current status of the Beall, Bjork-Shiley, Braunwald-Cutter, Lillehei-Kaster and Smeloff-Cutter cardiac valve prostheses. Am. J. Cardiol.35:855, 1975
Matloff, J.M., Collins, J.J., Sullivan, J.M., Gorlin, R., Harken, D.E.: Control of thromboembolism from prosthetic heart valves. Ann. Thorac. Surg.8:133, 1969
Cohn, L.H., Sanders, J.H., Collins, J.J.: Actuarial comparison of Hancock porcine and prosthetic disk valves for isolated mitral valve replacement. Circulation54[Suppl. III]:56, 1976
Zuhdi, N., Howley, W., Voehl, V., Hancock, W., Carey, J., Greer, A.: Porcine aortic valves as replacements for human heart valves. Ann. Thorac. Surg.17:479, 1974
Zuhdi, N.: The porcine aortic valve prosthesis. Ann. Thorac. Surg.21:573, 1976
Stinson, E.B., Griepp, R.B., Oyer, P.E., Shumway, N.E.: Long-term experience with porcine aortic valve xenografts. J. Thorac. Cardiovasc. Surg.73:54, 1977
McIntosh, C.L., Michaelis, L.L., Morrow, A.G., Itscoitz, S.B., Redwood, D.B., Epstein, S.E.: Atrioventricular valve replacement with the Hancock porcine xenograft: a five-year clinical experience. Surgery78:768, 1975
Horowitz, M.S., Goodman, B.J., Fogarty, T.J.: Mitral valve replacement with the glutaraldehyde-preserved porcine heterograft. J. Thorac. Cardiovasc. Surg.67:885, 1974
Hannah, H., Reis, R.L.: Current status of porcine heterograft prostheses—A five-year appraisal. Circulation54[Suppl. III]:27, 1975
Roberts, W.C., Bulkley, B.H., Morrow, A.G.: Pathologic anatomy of cardiac valve replacement: a study of 224 necropsy patients. Prog. Cardiovasc. Dis.15:539, 1973
Bjork, V.O., Henze, A.: Encapsulation of the Bjork-Shiley aortic disc valve prosthesis caused by the lack of anticoagulant treatment. Scand. J. Thorac. Cardiovasc. Surg.7:17, 1973
Pfeifer, J., Goldschlager, N., Sweatmen, T., Gerbode, F., Selzer, A.: Malfunction of mitral ball valve prosthesis due to thrombus: report of 2 cases with notes on early diagnosis. Am. J. Cardiol.29:95, 1972
Fernandez, J., Morse, D., Spagna, P., Lemole, G., Gooch, A., Yang, S.S., Maranhao, V.: Results of mitral valve replacement with the Beall prosthesis in 209 patients. J. Thorac. Cardiovasc. Surg.71:218, 1976
Johnson, A.D., Daily, P.O., Peterson, K.L., LeWinter, M., DiDonna, G.J., Blair, G., Niwayama, G.: Functional evaluation of the porcine heterograft in the mitral position. Circulation51 [Suppl. I]:40, 1975
Horowitz, M.S., Goodman, D.J., Hancock, E.W., Popp, R.L.: Noninvasive diagnosis of complications of the mitral bioprosthesis. J. Thorac. Cardiovasc. Surg.71:450, 1976
Owren, P.A.: The results of anticoagulant therapy in Norway. Arch. Intern. Med.111:240, 1963
Dale, J., Myhre, E., Storstein, O., Stormorken, H.: Proceedings: Arterial thromboembolism and prosthetic heart valves. Effect of acetylsalicylic acid. Thromb. Diath. Haemorrh.34:587, 1975
Dragojevic, D., Hetzer, R., Corterier, H.: Thromboembolie—Prophylaxe nach Herzklappenersatz in einem experimentellen Modell. Thoraxchirurgie20:419, 1972
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hetzer, R., Gerbode, F., Kerth, W.J. et al. Thrombotic complications after valve replacement with porcine heterografts. World J. Surg. 3, 505–510 (1979). https://doi.org/10.1007/BF01556120
Issue Date:
DOI: https://doi.org/10.1007/BF01556120