Key result
Early oral anticoagulation after bioprosthetic AVR is linked to ~5-mmHg lower mean transprosthetic gradient.
Why the study?
The study was designed to evaluate the clinical and echocardiographic outcomes in aortic valve replacement patients with aortic bioprosthesis under oral anticoagulation.
Does early oral anticoagulation decrease transprosthetic gradient and improve NYHA functional class in patients with aortic bioprosthesis?
Cohort (n=103)
No
Does early oral anticoagulation decrease transprosthetic gradient and improve NYHA functional class in patients with aortic bioprosthesis?
Early oral anticoagulation following bioprosthetic aortic valve replacement is associated with a lower transprosthetic gradient and greater functional improvement, particularly in smaller prostheses.
OBJECTIVE: To evaluate the clinical and echocardiographic outcomes in aortic valve replacement (AVR) patients with aortic bioprosthesis under oral anticoagulation (OA). METHODS: Patients who underwent AVR with bioprosthesiswere prospectively enrolled. They were classified based on postoperative use of OA. Clinical and operative variables were collected. Echocardiographic and clinical follow-ups were performed two years after surgery. The primary outcome evaluated was change in transprosthetic gradient. Secondary outcomes analyzed were change in New York Heart Association (NYHA) class, major bleeding episodes, hospitalization, stroke, and transient ischemic attack. RESULTS: We included 103 patients (61 without OA and 42 with OA). Clinical characteristics were similar among groups, except for younger age (76±6.3 vs. 72.4±8.1 years, P=0.016) and higher prevalence of atrial fibrillation (0% vs. 23.8%, P<0.001) in the OA group. Mean (21.4±10 mmHg vs. 16.8±7.7 mmHg, P=0.037) and maximum (33.4±13.7 mmHg vs. 28.4±10.2 mmHg, P=0.05) transprosthetic gradients were higher in patients without OA. Improvement in NYHA class was more frequent in patients with OA (73% vs. 45.3%, P=0.032). Major bleeding, stroke, and hospitalization were similar among groups. OA was the only independent predictor for improvement of NYHA class after multivariate logistic regression analysis (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 1.2-29.4; P=0.028). Stratification by prosthesis size showed that patients with ≤ 21 mm prosthesis benefited from OA. CONCLUSION: Early anticoagulation after AVR with bioprosthesis was associated with significant decrease of transprosthesis gradient and improvement in NYHA class. These associations were seen mainly in patients with ≤ 21 mm prosthesis.
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Dayan et al. (2020) conducted a cohort in Aortic valve replacement with bioprosthesis (n=103). Oral anticoagulation vs. No oral anticoagulation was evaluated on Mean transprosthetic gradient at 2-year follow-up (p=0.037). Early oral anticoagulation after aortic valve replacement with a bioprosthesis significantly decreased the mean transprosthetic gradient (16.8 vs 21.4 mmHg, p=0.037) and was associated with a higher rate of NYHA class improvement.
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