Work

P4583Is it safe to spare anticoagulation following mitral valve repair?

Year: 2018

Type: article

Abstract: Objective: To evaluate early and late morbidity as well as mortality among patients who received postoperative anticoagulation against those who did not receive anticoagulation after mitral valve repair. Methods: Retrospective comparative case-control study between February 2000–2017 in a single center. All patients undergoing mitral valve repair for severe mitral regurgitation due to degenerative disorder, Barlow's disease, or annular dilatation were included (n=379). The group of cases consisted of those patients who received elective mitral valve repair and anticoagulation after surgery (Anticoagulation-Group n=104). Patients who received anticoagulation before surgery and those of ischemic origin were excluded. Controls were patients who, by decision of the treating physiscians, did not receive anticoagulation after surgery (Non-Anticoagulation Group n=207). The primary endpoint was 30-day mortality, mortality at follow-up, need for re-intervention at follow-up, and freedom from stroke or events related to anticoagulation at follow-up. We performed a risk-adjusted analysis (propensity score) achieving a comparable population (n=196). The level of statistical significance was established as p<0.05. Results: Mortality (<30 days) was 1.3%, not different between both groups (p=0.154). The follow-up was completed in 90.1% with a median of 6.2 years (pc25–75: 2.4–9.1 years). There was no significant difference in survival at 9 years of follow-up (Anticoagulation-Group vs Non-Anticoagulation Group: 97.4% ± 1.8% vs 90.0% ± 2.8%, p log rank = 0.170). Neither there was a significant difference in the need for re-intervention (93.2% ± 3.0% vs 97.7% ± 1.3%, p log rank = 0.053), nor in freedom from stroke at follow-up (98.8% ± 1.2% vs 100%, p log rank = 0.665). However, there was a significant difference favouring the Non-Anticoagulation Group in freedom from the combined outcome of stroke and/or events related to anticoagulation (81.2±10.3% vs 98.8% ± 1.2%, p log rank = 0.001). In the risk adjusted analysis similar results were observed for long term survival (p=0.074), for the need for re intervention (p=0.131), and for freedom from stroke at follow-up (p=1.0) while the benefit of the Non-Anticoagulation Group (p log rank = 0.008) was maintained regarding events related to anticoagulation. Conclusion: Sparing anticoagulation (and its related adverse events) after mitral valve repair surgery is safe, given that it was not associated with a higher rate of stroke, nor with higher mortality, nor was it associated with a greater need for reoperation at 9 years of follow-up.

Source: European Heart Journal

DOI: 10.1093/eurheartj/ehy563.p4583