Should We Check Patient's Compliance More Carefully before Implantation of a Mechanical Aortic Valve Prosthesis?

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.

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