Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.
ABSTRACT Objective: To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. Study Design: It was a cohort study. Place and Duration of Study: The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients and Methods: Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. Results: In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Conclusion: Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.
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ABSTRACT: he indications for oral anticoagulant treatment have been extended over the last 10 years. The detection of new congenital thrombophilic risk factors, the stud- ies on non-valvar atrial fibrillation, and the increase in valvar heart surgery have all led to a rise in the number of patients being treated. In 1997, 64 000 valve operations were performed across Europe; in two thirds of these operations mechanical prostheses were used, subsequently requiring lifelong oral anticoagulant treat- ment. w1Heart (British Cardiac Society) 12/2000; 84(5):567-72. · 6.02 Impact Factor