THE USE OF TISSUE PROSTHESIS FOR MITRAL VALVE REPLACEMENT: POSSIBILITY OF DISCONTINUATION OF ANTICOAGULATION

Aim. To evaluate the clinical efficacy of gradual sinus rhythm restoration, including the bioprosthetic mitral valve replacement combined with maze radiofrequency ablation, external cardioversion and catheter ablation.

Methods.102 medical records of patients with mitral valve disease and long-standing atrial fibrillation (4,7±2,7 years) were restrospectively reviewed. Maze procedure was performed under extracorporeal circulation before the mitral valve replacement. The endpoints were monitored at the day of surgery, at discharge, and 3, 6 and 12 months after surgery.

Results.Sinus rhythm was recorded in 65.7% of patients at discharge from the hospital. The completeness of the follow-up was 80.4%. Steady regular rhythm was maintained in 64.6 % of patients in the study group. Other patients (35.4%) underwent cardioversion with the efficacy rate of 41.4%. Anticoagulation therapy was withdrawn in 65.9% of patients three months after surgery. 18.3% of patients with symptomatic arrhythmia underwent catheter ablation, which allowed to restore sinus rhythm in 73.3% of cases. Sinus rhythm was recorded in 92.7% of cases within the 1-year follow-up. Importantly, 79.3% of patients were discontinued of indirect anticoagulants.

Conclusion. Discontinuation of indirect anticoagulants proved its beneficial effects and safety on the restoration of sinus rhythm in patients after bioprosthetic mitral valve replacement.

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