Objective To investigate the vaccination rate of Coronavirus Disease 2019 (COVID-19) vaccine in patients undergoing cardiac mechanical valve replacement and to evaluate its effect on international normalized ratio (INR) value. MethodsWe investigated 132 patients who had received cardiac mechanical valve replacement and followed up in the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from May to October 2021. There were 51 males and 81 females aged 26-72 (53.01±9.51) years. ResultsThe vaccination coverage rate was 53.8%. Among the 61 unvaccinated patients, concerns about heart side-effects were the main reason. The average INR of the first review after vaccination was higher than that of the last review before vaccination, with a difference of 0.40±0.72 (P<0.001). ConclusionThe vaccination rate of patients after cardiac mechanical valve replacement is low. At the same time, COVID-19 vaccine may increase INR value, and it is suggested that patients should increase the frequency of review and adjust warfarin dosage after vaccination.
Abstract： Objective To summarize our operative experiences of cardiac reoperation after mechanical valve prosthesis replacement and investigate the causes of reoperation and the perioperative techniques and operation methods. Methods From January 2001 to December 2008, we performed reoperation on 105 patients (59 males and 46 females, aged 50.2±10.6 years old) who had undergone mechanical valve prosthesis replacement. Among the patients, there were 31 cases of mitral valvular replacement (+ tricuspid valvular plasticity), 38 cases of aortic valvular replacement (+ tricuspid valvular plasticity), 11 cases of Bentall procedure, 7 cases of mitral and aortic bivalvular replacement (+tricuspid valvular plasticity), 8 cases of tricuspid valvular replacement, 6 cases of repairing of prosthetic leakage, and 4 others cases. The time interval between two operations was 3 months to 18 years (46.3 ±31.9 months). Before reoperation, the cardiac function (NYHA) of the patients was class Ⅱ in 27 patients, class Ⅲ in 53 patients, and class Ⅳ in 25 patients. Results There were 6 hospital deaths with a mortality of 5.71%(6/105). All others recovered to NYHA class ⅠⅡ. The causes of mortality included 1 case of multiple organ failure, 1 case of low cardiac output after operation, 1 case of aortic pseudoaneurysm rupture, 1 case of severe infection due to brain complication and 2 cases of prosthetic valve endocarditis (PVE). The causes for cardiac reoperation after mechanical valve prosthesis replacement were 67 cases of prosthetic leakage (63.80%), 16 cases of PVE (15.23%), 14 cases of prosthetic thrombosis (13.33%) and 8 cases of other valvular anomalies. Followup was done for 11 to 107 months, which showed two cases late deaths of cardiac arrest and cerebral hemorrhage. Conclusion Patients who have received mechanical valve prosthesis replacement may undergo cardiac reoperation due to paravalvular prosthetic leakage, paravalvular endocarditis, and prosthetic thrombosis. The keys to a successful cardiac reoperation include appropriate preoperative preparations, operational timing, and suitable choosing of cardiopulmonary bypass and operational skills.
ObjectiveTo evaluate the quality of warfarin anticoagulant therapy in patients with stable stage after mechanical valve replacement surgery, to observe the effect of compound salvia miltiorrhiza tablet on the anticoagulant effect of warfarin in patients after mechanical valve replacement, and to understand the impact of genetic polymorphisms of VKORC1, CYP2C9 and CYP4F2 on warfarin resistance in patients with mechanical valve replacement in the stable period.MethodsFrom July 2011 to February 2014, 1 831 patients who had ≥ 6 months after mechanical valve replacement surgery were enrolled at the outpatient follow-up. The basic clinical data were recorded. Anticoagulant therapy uses a target international normalized ratio（INR, 1.60–2.20) and a weekly warfarin dose adjustment strategy. Forty-six patients who needed compound salvia miltiorrhiza tablet were screened and the INR values. Before and after taking tablets were recorded and compared. The patients were divided into three groups according to the percentile of warfarin dosage including a warfarin sensitive patients group, a control patients group, and a warfarin resistance patients group. And 101 of them were selected. TIANGEN blood DNA Kit blood genomic DNA extraction kit was used to extract samples and polymerase chain restriction fragment length polymorphism (PCR-RELP) was used to determine the genotypes of patients. The detected gene loci included CYP4F2: rs2108622C>T locus; VKORC1:1639G>A locus; VKORC1:1173C>T locus; CYP2C9*2: rs1799853C>T locus; CYP2C9*3:1061A>C locus.ResultsThe time in therapeutic range (TTR) and fraction of time in therapeutic range (FTTR) in the target INR range of the patients included in the study period was 27.2% and 49.4%, respectively, and the TTR and FTTR in the acceptable INR range was 34.25% and 63.36%, respectively. Before and after the addition of compound salvia miltiorrhiza tablets, the INR value was 1.55±0.03 and 1.69±0.30, respectively, and the difference was statistically different (P<0.05). A total of 101 patients with genetic testing, in which the C/T composition of the VKORC1: 1173C>T locus increased in the warfarin sensitivity, contrast and warfarin resistance patients, while the ratio of allelic loci of C/T in CYP2C9*3: 1061A>C loci decreased in turn. There was no difference in the CYP4F2 gene, VKORC1639 gene, and CYP2C9*2 locus. The IWPC model predicts that warfarin dose is only consistent with the actual warfarin dose in warfarin sensitive patients.ConclusionRelatively low TTR and FTTR are acceptable in patients with stable stage after mechanical valve replacement. It is beneficial to the patients with compound salvia miltiorrhiza tablets in terms of some appropriate patients. VKORC1: 1173C>T site and CYP2C9*3: 1061A>C site mutation is the main pharmacological gene factor of warfarin dose sensitivity and warfarin resistance in stable period after mechanical valve replacement. The IWPC dose prediction model is only consistent with the actual dose of warfarin sensitive patients.
The body is at a hypo-coagulation status after the heart mechanic valve prosthesis replacement operation, and the incidence of anticoagulation complications is rather high because of that administration of warfarin may result in “anticoagulation vacuum” at an early stage. Moreover, the necessary application of other anticoagulation methods assisting the employment of warfarin have still not been scientifically normalized. Blood coagulation factor Ⅱ,Ⅶ, prothrombin fragment1+2 (F1+2 ), urine fibrimopeptide A (UFPA) , and International Normalized Ratio(INR), could exactly reflect the anticoagulation intensity 48-72 hours after the replacement operation,reasonable use of anticoagulant therapy as well as accurate and in-time monitoring methods is significant to reduce complications,elevate survival rate, and improve quality of life.
ObjectiveTo explore the anticoagulant strategy of adjusting the dose of warfarin at different stages after mechanical valve replacement of mitral valve.MethodsClinical data of a total of 302 patients, including 76 males and 226 females, with an average age of 50.1±10.1 years, who underwent mechanical mitral valve replacement in the Chinese adult cardiac surgery database from 2013 to 2017 were retrospectively analyzed. According to the dose adjustment strategy of taking warfarin, the patients were divided into a D group (adjusting warfarin dose in days) and a W group (adjusting warfarin dose in weeks) to evaluate the anti-coagulation effect of warfarin.ResultsThe total follow-up time was 423277 d (1159.7 years). There was no significant difference in the overall anticoagulant strength, and the warfarin dose adjusted in days was better in the early postoperative period (P<0.05), especially in patients over 60 years. It was better to adjust warfarin dose in weeks in the middle and long periods (P<0.05), especially in patients ≤40 years. In terms of the stability of anticoagulation, it was better to adjust the dosage of warfarin in weeks (P<0.05). It was better to adjust the dosage of warfarin in weeks for early, middle- and long-term anticoagulant therapy after operation (P<0.05), especially in the females aged >40 and ≤50 years.ConclusionWithin the target range of international normalized ratio (1.5-2.5), the anticoagulant strategy of adjusting warfarin dose in days after mechanical valve replacement of mitral valve can achieve a better anticoagulant strength, and adjusting the dosage of warfarin in weeks is better in the middle- and long-term after operation. In general, the anticoagulant effect is more stable in the short term when warfarin dose is adjusted on a weekly basis.
ObjectiveTo describe the status of quality of life (QOL) and self-management behavior in patients following mechanical heart valve replacement, and explore the relationship between QOL and self-management behavior. MethodsConvenient sampling was used to recruit 352 patients following mechanical heart valve replacement in a high-level hospital in Chengdu between January 2011 and June 2012. General information questionnaire, MOS SF-36 scales, and self-management behavior questionnaire were used to collect data. T-test was used to analyze the difference between patients and normal people. And correlation analysis was used to see the correlation between QOL and self-management. ResultsFor MOS SF-36 scale results in patients within one year after surgery, physical functioning (PF) score was 73.44±15.11, role-physical (RP) was 49.52±39.17, body pain (BP) was 63.13±17.93, general health (GH) was 58.85±14.88, vitality (VT) was 63.54±18.10, social functioning (SF) was 76.67±17.40, role-emotional (RE) was 64.96±41.37, and mental health (MH) was 72.76±17.40. All these scores of the patients were significantly lower than the norm of Sichuan Province (P<0.05) except the dimension of mental health. For patients one year or more after surgery, PF score was 76.53±14.41, RP 58.44±39.21, BP 68.16±18.26, GH 61.39±13.57, VT 68.47±16.37, SF 79.79±19.34, RE 72.94±37.29, and MH 75.87±14.70, among which PF, RE, BP and GH scores were lower than the norm (P<0.05). The average total score of self-management behavior was 143.21±20.63. QOL and self-management behavior were positively correlated. ConclusionThere is still a gap between patients following mechanical heart valve replacement and normal people in terms of quality of life. Patients' self-management behavior is positively correlated with the quality of life. Good self-management behavior contributes to the improvement of QOL.
ObjectiveTo investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. MethodsA retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. ResultsA total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). ConclusionBMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.
Objective To explore the role of thrombus precursor protein(TPP) in the monitoring of anticoagulation in the patients with atrial fibrillation (Af) after mechanical heart valve replacement, and suggest the reasonable anticoagulant range. Methods Ninety patients were divided into Af group (n=45), sinus rhythm group (SR group, n=45), and control group (20 patients with non-valvular heart diseases), according to whether Af exist after mitral valve replacement. TPP concentrations and International Normalized Ratio(INR) in the anticoagulant patients were analyzed. Results In patients after mechanical mitral valve replacement, plasma TPP concentrations in both SR group and Af group were lower than that in control group (Plt;0.05,0.01), their INR value were higher than that in control group (Plt;0.01), and Af group had higher plasma TPP concentrations than that in SR group((Plt;)0.05). It was found that there existed contradictions between INR and plasma TPP concentrations in Af group. There were 28 patients with plasma TPP concentrations below 6 μg/ml and without spontaneous bleeding complications in the group with Af, who might be at the optimal anticoagulant status. Their 95% confidence of INR value was 1.90-2.30 and their plasma TPP concentration was 4.29±0.75μg/ml. Conclusion Patients with Af after mechanical heart valve replacement might have higher risk of thromboembolism, INR between 1.90 - 2.30 and plasma TPP concentration between 2.84-6.00 μg/ml might be the optimal anticoagulant therapeutic range.
目的 探讨心脏机械瓣膜置换术后患者出院指导的综合方法，评价其效果。 方法 将2010年9月－2011年1月242例心脏机械瓣膜置换术患者按入院先后顺序随机分成试验组和对照组。试验组患者采用综合出院指导方案，对照组采用常规宣教方法，在6个月后对两组患者进行调查，评价综合指导方案的效果，并进行统计学分析。 结果 试验组患者均未出现不良并发症，对照组有1例出院后未遵医嘱服药及定期复查，死于血管栓塞；有2例出现血管栓塞，2例牙龈出血，经及时治疗后好转。 结论 对心脏机械瓣膜置换术患者出院时，发放健康教育资料及定期随访指导的综合出院指导方案，可以降低术后并发症，提高患者认知水平和满意度，帮助患者提高依从性，提高生存质量。