Prosthetic Heart Valves

#med #disease #y2023

Overview :

Mechanical valves are more durable than bioprosthetic valves but require lifelong anticoagulation
Prosthetic valves in the aortic position are more durable and less prone to thromboembolism than valves in the mitral position.

Lifelong oral anticoagulation with warfarin is required for mechanical prosthesis. Target INRs are:
- 2.5 for an aortic prosthetic valve (bileaflet or current-generation single-tilting disc) without thromboembolism risk factors
- 3.0 for ball-in-cage aortic prosthetic valve with thromboembolism risk factors
- 3.0 for any mitral valve prosthesis
AC Interruptions:
- Interrupt anticoagulation in patients with a prosthetic heart valve before noncardiac or dental surgery (but not cataract surgery).
- For aortic valve prostheses, stop warfarin 4 to 5 days before the procedure and restart as soon as postprocedure control of bleeding allows.
- In patients at high risk for thrombosis (mitral prostheses, multiple prosthetic valves, AF, or previous thromboembolic events), stop warfarin 4 to 5 days before surgery and begin bridging anticoagulation with IV heparin; resume IV heparin within 24 hours after surgery. Warfarin is also reinitiated after surgery, and heparin is discontinued when INR is therapeutic.
Bioprosthetic heart valves DO NOT require long-term anticoagulation