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J Thorac Cardiovasc Surg 2004;127:1166-1170
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Thromboembolic events after aortic valve replacement in elderly patients with a Carpentier-Edwards Perimount pericardial bioprosthesis

^a Laboratory for Human Anatomy and Embryology, University of Antwerp, Antwerp, Belgium
^b Department of Cardiovascular Surgery, General Hospital Middelheim, Antwerp, Belgium
^c Department of Physiology, Biochemistry, and Biometrics, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium

Received for publication June 19, 2003; revisions received October 29, 2003; accepted for publication November 4, 2003.

^* Address for reprints: Wilhelm Mistiaen, MD, PhD, Laboratory for Human Anatomy, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
mistiaen{at}ruca.ua.ac.be

OBJECTIVES: Thromboembolic events after aortic valve replacement with a bioprosthesis were the most frequently occurring complications in elderly patients. Whether this was valve related or dependent on other factors needed further exploration.

METHODS: Five hundred patients with a median age of 73 years were followed retrospectively after aortic valve replacement with a pericardial prosthesis for occurrence of thromboembolism. Of these, 348 also underwent coronary artery bypass grafting. Twenty-five factors were investigated for their potential effect by using univariate and multivariate analysis.

RESULTS: Univariate analysis revealed 6 significant factors: preoperative endocarditis (P = .0001), preoperative cerebrovascular accident (P = .002), use of postoperative warfarin sodium (Coumadin, DuPont Merck; P = .006), arterial hypertension (P = .023), size of valve prosthesis of 27 mm or larger (P = .023), and hospital thromboembolism (P = .040). There was a trend toward increased fatal thromboembolism in patients without medication. With a multivariate analysis, 4 factors remained significant: preoperative cerebrovascular accident (risk ratio, 4.8; P = .0016), warfarin sodium (risk ratio, 3.0; P = .0028), preoperative endocarditis (risk ratio, 5.6; P = .006), and hospital thromboembolism (risk ratio, 6.1; P = .016). Hypertension had a borderline effect. Age, sex, diabetes, 4 coronary artery factors, 3 other valvular factors, atrial fibrillation, and carotid artery disease had no significant effect.

CONCLUSIONS: Some emboli seemed triggered by the valve prosthesis. A proper anticoagulant protocol but also a treatment of hypertension is important in the prevention of thromboembolism after aortic valve replacement with a bioprosthesis. We did not find a significant role of atrial fibrillation and carotid artery disease.

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