The bioprosthetic valve of choice for high-risk patients: long-term results (up to 10 years).

Patients with chronic atrial fibrillation, giant left atrium, left atrial thrombi, and previous embolic accidents are usually treated with life-long anticoagulation after bioprosthetic mitral valve replacement for fear of increased thromboembolic accidents. However, we studied 306 patients in whom we implanted 381 bioprostheses between January 1976 and May 1984, with variations of anticoagulation therapy. The patients' ages ranged between 19 and 68 years, with a mean of 46.2 years. Eighty-six patients were in the New York Heart Association Functional Class II (28.1%), 149 were in Class III (48.7%), and 71 were in Class IV (23.2%). In 90% of the cases, the lesions were rheumatic in origin; the remaining cases were due to bacterial endocarditis, and congenital or ischemic lesions. By analyzing our results, we concluded that high-risk patients with bioprosthetic mitral valves can be safely and advantageously managed with postoperative, temporary anticoagulation.