Objective: Well managed anticoagulation is the most important concern after mechanical aortic
valve replacement. Greatly feared complications are valve thrombosis, ischemic and
hemorrhagic stroke and bleeding.
Methods: 318 patients (mean age: 45.8 ± 8.1 years, range: 16.9–55.0 years; 74.5% male) had
a mechanical aortic valve replacement in our hospital from June 1993 to January 2014
(mean follow-up: 8.5 ± 5.8 years, range: 4 days to 20.84 years, completeness of follow
up 95.9%). Long-term data were collected with retrospective data acquisition, clinical
examination at last follow-up, phone conferences with the practitioners of the patients
and the patients themselves (questionnaire of e.g., quality of anticoagulation, complications,
reoperations, mortality, quality of life).
Results: 7.5% of the patients had an emergency operation, in hospital mortality was 1.9% and
late mortality was 18.2% from any case. Reoperation rate of the mechanical valve prosthesis
was 0.6%/patient year (31% endocarditis, 12.5% paravalvular leakage, 3% enhanced pressure
gradient and 3% thrombosis). In 98.5% patients had an anticoagulation therapy with
phenprocoumon, 64.7% managed their anticoagulation therapy themselves, 35.3% were
controlled by their practitioners. Overall only 12.5% of the patients had INR according
to the guidelines (17.2% self-management, 4.1% practitioner).
Conclusion: In our study in patients with mechanical aortic valve prostheses anticoagulation
was inadequately managed in most cases. Anticoagulation management was more effective
in patient's self-management than in practitioners. Keeping this alarming results
in mind we should discuss a very careful informed decision-making with our patients.
