BACKGROUND:
Freedom from anticoagulation (AC) is the principle advantage of bioprostheses, however AHA/ACC guidelines recommend AC with warfarin for 3 months after xenograft aortic valve replacement (AVR). We therefore examined neurologic events within 90 days of bioprosthetic AVR.
METHODS:
Between 1993 and 2000, 1160 patients underwent bioprosthetic AVR with (644) or without (516) associated coronary artery bypass (CAB). By surgeon preference, 629 (55%) had early postoperative anticoagulation (AC+) and 527 (45%) did not (AC-). In the AC- group, 410 pt (78%) received antiplatelet therapy. Groups were similar with respect to gender (% female 36.1 AC+ vs 39.7 AC-, p=0.22), hypertension (64.5% AC+ vs 61.1%, p=0.24), and prior stroke (7.3% AC+ vs 8.7% AC-, p=0.39). The AC+ group was slightly younger than AC- (mean 76 years vs mean 78 years, p=0.007). 121 patients had prior CAB (10%).
RESULTS:
Operative mortality was 4.1% with 43 permanent or transient cerebrovascular events (CVA) within 90 days (3.7%). Excluding 18 deficits noted upon emergence from anesthesia, the incidence of postoperative CVA was 2.7% for AC+ and 1.5% for AC- (p=0.17). By multivariable analysis, predictors of operative mortality included hypertension (p=0.0009), prior CVA (p=0.0005), and advanced age (p<0.001), but only peripheral vascular disease predicted postoperative stroke (p=0.04). The incidence of mediastinal bleeding requiring re-exploration (6.4% vs 7.8%, p= 0.35) or of other bleeding complications in the first 90 days (1.8% vs 1.3%,p=0.77) was not different between AC+ and AC-.
CONCLUSIONS:
These data do not support early anticoagulation after bioprosthetic AVR for prevention of neurological events.

Back to Final Program