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Is it Time to Look for an Alternative?

Department of Cardiovascular Surgery Damascus University Medical School Damascus, Syria

In a recent meeting, the issue of mechanical versus tissue valve substitutes was being discussed and one of the panelists made the remark in favor of mechanical prostheses that "to take a pill or two a day [of anticoagulant] is no big deal!" Well, is it not?

In countries that boast optimal education and health facilities, thromboembolic complications of valve replacement are reported within the range of 1 to 3 per 100 patient-years.¹ However, once we move to regions with less fortunate economic and health standards, we encounter a totally different picture. Patients are often too poor to afford the medications and laboratory tests that are a prerequisite to anticoagulation. They frequently lack the health awareness necessary for an altered demanding lifestyle. Nor is the uncertain quality of medications and laboratory facilities in these regions, or the fact that the valve in question is often the mitral, the more notorious for thromboembolic complications, of any help in this regard.

In a study of patients followed up after mitral valve replacement with the St. Jude Medical valve in an Indian community hospital, the risk of thromboembolism was 12.5 per 100 patient-years. This rose to 22.2 per 100 patient-years in double valve replacement. Subtherapeutic anticoagulation was considered the key factor . . . [Full Text of this Article]

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