Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in patients after Mitral Valve Replacement

Abstract Background:This study aimed to evaluate the role of SAMe-TT2R2 score in the prediction of anticoagulation control after mechanical mitral valve replacement.Methods and Results:We retrospectively reviewed clinical data of 161 patients who received mechanical mitral valve replacement at Beijing Anzhen Hospital from January 2013 to December 2013. Collected data included general information of patients, medication and smoking, postoperative embolism due to anticoagulant, bleeding complications and death information. In the SAMe-TT2R2 score results, the lowest score was 2 points (6.3%), the highest score was 7 points (0.7%). The number of people with 4 points was the largest ,60 people (41.4%).When the cut-off value of SAMe-TT2R2 score was set to ≥4, the sensitivity and specificity of predicting TTR≥65% were 69.8% and 93.1%, respectively. The Youden index was 0.629. If the cut-off value of SAMe-TT2R2 score was set to ≤4, the sensitivity and specificity of predicting TTR≥65% were 93.0% and 44.1%, respectively, and the Youden index was 0.371.ROC curve evaluates the predictive power of the SAMe-TT2R2 score for TTR≥65%. The figure showed that when the cut-off point≥4, the best combination of sensitivity and specificity was shown (69.8% and 93.1%, respectively).The area under the curve AUC was 0.854.Conclusions:After mechanical mitral valve replacement, the SAME-TT2R2 model can effectively predict the level of TTR during the course of using oral warfarin anticoagulation, and the SAMe-TT2R2 score ≥4 can be used to predict TTR<65%.

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Thromboembolic and bleeding complications after mitral valve replacement

European Journal of Cardio-Thoracic Surgery ◽

10.1016/1010-7940(90)90020-z ◽

1990 ◽

Vol 4 (11) ◽

pp. 605-612 ◽

Cited By ~ 17

Author(s):

U EBERLEIN ◽

J VONDEREMDE ◽

J REIN ◽

H ESPERER

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Bleeding Complications

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Results of Randomized Mitral Valve Replacement with Mechanical Prostheses after 15 Years

The International Journal of Artificial Organs ◽

10.1177/039139889201501008 ◽

1992 ◽

Vol 15 (10) ◽

pp. 611-616 ◽

Cited By ~ 3

Author(s):

H.D. Schulte ◽

D. Horstkotte ◽

W. Bircks ◽

B.E. Strauer

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Cumulative Risk ◽

Bleeding Complications ◽

Severe Bleeding ◽

Mechanical Prostheses ◽

Valve Thrombosis ◽

Long Term Follow Up

Between 1974 and 1976 150 consecutive patients (pts) were operated on for isolated mitral valve replacement (MVR). Björk-Shiley (BS), Lillehei-Kaste (LK), and Starr-Edwards (SE) (type 6210) prostheses were implanted at random. All survivors were prospectively followed by regular clinical examinations every 6 to 12 months for 15 years. The mean follow-up time was 14.8 years. A constant subjective improvement after 15 years was reported in 62% of pts with BS, 30% with LK, and 49% with SE. The cumulative 14-year survival rate was 0.62 ± 0.13 (BS), 0.56 ± 0.16 (SE), and 0.54 ± 0.15 (LK), respectively. Late mortality was due to thromboembolic events (n=3), bleeding complications (n=3), congestive heart failure (n=7), documented arrhythmias or sudden death (n=6). Thrombotic valve thrombosis (1 BS, 1 LK, 2 SE) required reoperations. Linearized cumulative rates after 14 years for thromboembolic complications were 14.2 ± 3.1 (BS), 15.8 ± 3.7 (SE), 24.3 ± 4.2 (LK). The cumulative risk of severe bleeding complications was not different: BS: 35.8, LK: 35.2, SE: 34.3. During the first years of observation no significant differences between these mechanical prostheses could be observed, however, after 14 years of long-term follow-up the cumulative event-free rates were more favorable for the BS prosthesis.

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Long-term thromboembolic and bleeding complications after isolated bioprosthetic mitral valve replacement: Incidence, predictors and clinical implications

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.148 ◽

2019 ◽

Vol 11 (1) ◽

pp. 68

Author(s):

M. Dupuis ◽

T. Bourguignon

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Bleeding Complications ◽

Clinical Implications ◽

Bioprosthetic Mitral Valve

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Current Status of Catheter-based Mitral Valve Replacement

Current Cardiology Reports ◽

10.1007/s11886-021-01524-0 ◽

2021 ◽

Vol 23 (8) ◽

Author(s):

Elias Rawish ◽

Tobias Schmidt ◽

Ingo Eitel ◽

Christian Frerker

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Ventricular ◽

Current Status ◽

Bleeding Complications ◽

Thrombotic Risk ◽

Surgical Risk ◽

Transcatheter Mitral Valve Replacement ◽

High Surgical Risk

Abstract Purpose of review Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. Recent findings Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Summary Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.

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