PMID- 18654094
OWN - NLM
STAT- MEDLINE
DCOM- 20081103
LR  - 20191111
IS  - 1875-2136 (Print)
IS  - 1875-2128 (Linking)
VI  - 101
IP  - 4
DP  - 2008 Apr
TI  - Choice of echocardiography method for postoperative evaluation of mitral valve 
      replacement with a mechanical prosthesis.
PG  - 204-12
AB  - OBJECT: The French Cardiology Society (SFC) systematically recommends (Class I) 
      transesophageal echocardiography (TEE) after any mitral valve replacement with a 
      mechanical prosthesis (MMVR). Taking into account the increasing workload of 
      echocardiography laboratories, our attitude was to propose that only 
      post-operative transthoracic echocardiography (TTE) is performed. The purpose of 
      this study was to evaluate the possible risks of this simplified procedure. 
      METHODS: We performed a precise analysis of one full year of practice of MMVR 
      with exhaustive follow-up for the first 2 years concentrating on thromboembolic 
      complications. RESULTS: From January to December 2003, 84 MMVRs (46 after 
      rheumatic fever, 22 degenerative disease, 11 infective endocarditis (IE) and 5 
      ischemia) were conducted in 45 women and 39 men of average age 61 years. Early 
      mortality (<30 days) concerned 5 patients (5.9%). A control TTE to determine 
      normal prosthetic function was performed 7+/-2 days after surgery and this 
      revealed 2 cases of nonobstructive thrombosis which were treated medically, 3 
      cases of paraprosthetic regurgitation, and 1 vegetation due to underlying IE. 
      Actuarial survival was 90.5% at 1 year and 83.3% at 2 years. After a mean 
      follow-up of 179.3 patient-years, 5 patients were reoperated (5.9%): 1 for IE, 1 
      for paravalvular regurgitation, 1 for mitral valve insufficiency with haemolysis, 
      and 2 for obstructive prosthetic valve thromboses. In addition there were 2 cases 
      of prosthetic valve thrombosis, 8 ischemic strokes (2 ministrokes, 6 sequelar 
      strokes), and 1 peripheral embolism. The global thromboembolic complication rate 
      was therefore 6.1 per 100 patient-years (n=11). There were 4 hemorrhagic events, 
      i.e. a rate of 2.2 events per 100 patient-years. 63% of the 1193 INR conducted 
      were within the target range (3-4.5), 26% were below 3 and 11% were greater than 
      4.5. 35% of patients with thromboembolic complications had an INR<3. CONCLUSION: 
      Morbidity and mortality during the first 2 years after MMVR were relatively high 
      but equivalent to the values of comparable series in the literature. These 
      complications would not have been reduced by a more precise screening based on 
      early TEE. Despite the increasingly litigious nature of the doctor-patient 
      relationship, it would probably be excessive to oppose that this guideline was 
      not followed in a dispute; in particular as it is difficult to apply this measure 
      as echocardiography departments are overworked.
FAU - Greffe, G
AU  - Greffe G
AD  - Departement de chirurgie cardiaque et transplantation, Hopital Cardiothoracique 
      Louis-Pradel, Lyon-Bron.
FAU - Henaine, R
AU  - Henaine R
FAU - Metton, O
AU  - Metton O
FAU - Nloga, J
AU  - Nloga J
FAU - Wautot, P
AU  - Wautot P
FAU - Robin, J
AU  - Robin J
FAU - Ninet, J
AU  - Ninet J
FAU - Saroul, C
AU  - Saroul C
FAU - Barthelet, M
AU  - Barthelet M
FAU - Derumeaux, G
AU  - Derumeaux G
FAU - Obadia, J-F
AU  - Obadia JF
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Arch Cardiovasc Dis
JT  - Archives of cardiovascular diseases
JID - 101465655
SB  - IM
MH  - Aged
MH  - Echocardiography/*methods
MH  - Embolism/etiology
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - International Normalized Ratio
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - *Postoperative Care
MH  - Postoperative Complications/*diagnostic imaging/mortality
MH  - Reoperation
MH  - Stroke/etiology
MH  - Thrombosis/etiology
EDAT- 2008/07/26 09:00
MHDA- 2008/11/04 09:00
CRDT- 2008/07/26 09:00
PHST- 2008/07/26 09:00 [pubmed]
PHST- 2008/11/04 09:00 [medline]
PHST- 2008/07/26 09:00 [entrez]
AID - S1875-2136(08)73694-5 [pii]
AID - 10.1016/s1875-2136(08)73694-5 [doi]
PST - ppublish
SO  - Arch Cardiovasc Dis. 2008 Apr;101(4):204-12. doi: 10.1016/s1875-2136(08)73694-5.