Thromboembolic (TE) and hemorrhagic (H) complications are the most significant problems in patients treated with oral anticoagulants (OA) after implantation of artificial valvular prostheses of heart. This problem was discussed in worlds scientific literature, but was not comprehensive investigated in Polish population of patients. The aim of the study was to assess the frequency of TE and H complications and their influence on mortality and morbidity and to determine the risk factors related to clinical and hemodynamical patients status.
Material and methods: Between December 1997 and December 1998, 358 patients hospitalized in our Department were qualified for cardiac surgery. There were 177 women and 181 men with a mean age 56.9+/-10.3 (range 21-80 years), who underwent 144 mitral, 172 aortic, 42 both artificial heart valve replacement. All patients were followed prospectively.
Results: Follow up was 100% complete and averaged 36.7+/-12.1 months. The total follow-up was 1109.8 pty. Linearized incidents of death was 2.1%/pty (30 patients). TE events were in 30 patients (2.7%/pty). H events occurred in 46 patients (4.15%/pty). The TE and H complications were the most important causes of morbidity and mortality in observed population of patients after mechanical heart valve replacement. Frequency of complications was inside the broad spectrum of values presented in the literature.
Conclusions: The independent risk factors of death were: lower EF (RR: 1.06; CI 95%: 1.02-1.08), advanced functional NYHA class in presurgery period (RR: 3.5; CI 95%: 1.1-8.2) and advanced functional NYHA class in postsurgery period (RR: 7.5; CI 95%: 3.6-15.5). The independent risk factor of TE as well H complications was an advanced functional NYHA class in perioperative period (respectively for TE and H complications RR: 4.2; CI 95%: 1.9-8.9 and RR: 3.2; CI 95%: 1.5-6.7). In the group with artificial heart valve in reference to the severe (class III) complications of postoperative period-independent risk factors were atherosclerosis risk factors (hypertension, hypercholesterolemia, diabetes and smoking) (RR: 2.4; CI 95%: 1.3-5.6).