Domenico Paparella1, Michele Di Mauro2, Keren Bitton Worms3, Gil Bolotin3, Claudio Russo4, Salvatore Trunfio4, Roberto Scrofani5, Carlo Antona5, Guglielmo Actis Dato6, Riccardo Casabona6, Andrea Colli7, Gino Gerosa7, Attilio Renzulli8, Filiberto Serraino8, Giuseppe Scrascia9, Salvatore Zaccaria9, Michele De Bonis10, Maurizio Taramasso10, Luis Delgado11, Francesco Tritto12, Joseph Marmo12, Alessandro Parolari13, Veronika Myaseodova14, Emmanuel Villa15, Giovanni Troise15, Francesco Nicolini16, Tiziano Gherli16, Richard Whitlock17, Manuela Conte18, Fabio Barili19, Sandro Gelsomino20, Roberto Lorusso21, Edoardo Sciatti21, Daniele Marinelli22, Gabriele Di Giammarco22, Antonio Maria Calafiore23, Azmat Sheikh23, Juan Jaime Alfonso23, Mattia Glauber24, Antonio Miceli24. 1. U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy. Electronic address: domenico.paparella@uniba.it. 2. U.O. Cardiologia Università dell'Aquila, Italy. 3. Department of Cardiac Surgery, Rambam Medical Centre, Haifa, Israel. 4. U.O. Cardiochirurgia Ospedale Niguarda Milano, Italy. 5. U.O. di Chirurgia Cardiovascolare, Ospedale Polo Universitario Luigi Sacco, Milano, Italy. 6. U.O. Cardiochirurgia, Ospedale Mauriziano, Torino, Italy. 7. U.O. di Cardiochirurga, Dipartimento di Scienze Cardio-toraco-vascolare, Università di Padova, Italy. 8. Divisione di Cardiochirurgia, Università della Magna Grecia, Catanzaro, Italy. 9. U.O. Cardiochirurgia, Ospedale Vito Fazzi, Lecce, Italy. 10. U.O. Cardiochirurgia, Ospedale San Raffele, Milano, Italy. 11. Ospedale Universitario Germans Trias Y Pujol, Badalona, Spagna. 12. U.O. Cardiochirurgia, Ospedale S. Anna E S. Sebastiano, Caserta, Italy. 13. Divisione di Cardiochirurgia, IRCCS San Donato, San Donato Milanese, Italy. 14. Unità di Ricerca Clinica in Aterotrombosi, Centro Cardiologico Monzino, Milano, Italy. 15. Divisione di cardiochirurgia, Ospedale Poliambulanza, Brescia, Italy. 16. Unità di Cardiochirurgia, Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy. 17. Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada. 18. U.O. di Cardiochirurgia Università di Bari Aldo Moro, Italy. 19. Division of Cardiac Surgery, Santa Croce hospital, Cuneo, Italy. 20. Experimental Surgery, Heart and Vessels Department, Careggi Hospital, Firenze, Italy. 21. U.O. Cardiochirurgia, Spedali Civili, Brescia, Italy. 22. U.O. di Cardiochirurgia, Università di Chieti, Chieti, Italy. 23. Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. 24. U.O. Cardiochirurgia, Ospedale Monasterio, Massa, Italy.
Abstract
OBJECTIVE: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome. METHODS: Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 ± 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286). RESULTS: No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P = .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P = .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P = .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months. CONCLUSIONS: Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.
OBJECTIVE: To verify the rate of thromboembolic and hemorrhagic complications during the first 6 months after mitral valve repair and to assess whether the type of antithrombotic therapy influenced clinical outcome. METHODS: Retrospective data were retrieved from 19 centers. Inclusion criteria were isolated mitral valve repair with ring implantation. Exclusion criteria were ongoing or past atrial fibrillation and any combined intraoperative surgical procedures. The study cohort consisted of 1882 patients (aged 58 ± 15 years; 36% women), and included 1517 treated with an oral anticoagulant (VKA group) and 365 with antiplatelet drugs (APLT group). Primary efficacy outcome was the incidence of arterial thromboembolic events within 6 months and primary safety outcome was the incidence of major bleeding within 6 months. Propensity matching was performed to obtain 2 comparable cohorts (858 vs 286). RESULTS: No differences were detected for arterial embolic complications in matched cohort (1.6% VKA vs 2.1% APLT; P = .50). Conversely, patients in the APLT group showed lower incidence of major bleeding complications (3.9% vs 0.7%; P = .01). Six-month mortality rate was significantly higher in the VKA group (2.7% vs 0.3%; P = .02). Multivariable analysis in the matched cohort found VKA as independent predictor of major bleeding complications and mortality at 6 months. CONCLUSIONS:Vitamin K antagonist therapy was not superior to antiplatelet therapy to prevent thromboembolic complications after mitral valve repair. Our data suggest that oral anticoagulation may carry a higher bleeding risk compared with antiplatelet therapy, although these results should be confirmed in an adequately powered randomized controlled trial.
Authors: Devendra Saksena; Yugal K Mishra; S Muralidharan; Vivek Kanhere; Pankaj Srivastava; C P Srivastava Journal: Indian J Thorac Cardiovasc Surg Date: 2019-01-28
Authors: Tessa M F Watt; Shannon L Murray; Alexander A Brescia; David A Burn; Alexander Wisniewski; Shazli P Khan; Matthew A Romano; Steven F Bolling Journal: J Card Surg Date: 2020-08-02 Impact factor: 1.620
Authors: Sake J van der Wall; Jules R Olsthoorn; Samuel Heuts; Robert J M Klautz; Anton Tomsic; Evert K Jansen; Alexander B A Vonk; Peyman Sardari Nia; Frederikus A Klok; Menno V Huisman Journal: J Thromb Thrombolysis Date: 2018-11 Impact factor: 2.300