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eComment: Freedom from complications related to dual ball-and-cage mechanical valve prostheses despite thirty years without anticoagulation

Bakoulev Center for Cardiovascular Surgery, 121552 Moscow, Russia

Freedom from complications related to dual ball-and-cage mechanical valve prostheses despite thirty years without anticoagulation

We read with interest the case report by Matthew and colleagues describing a patient with a dual ball-and-cage valve that was managed long-term without anticoagulant therapy [1].

It is well known that different types of mechanical valves have different risks of thrombosis and that valves are more thrombogenic in the mitral position than in the aortic position. The risk is highest for ball-in-cage valves, followed by single tilting disk prostheses and then bileaflet tilting disk prostheses. Therefore the level of anticoagulation depends on the type of valve and the valve position. The European Society of Cardiology recommends a target INR of 3.5–4.0 for patients with caged-ball valves [2].

We agree that antiplatelet agents alone do not protect patients with mechanical prostheses. Although it seems impossible for mechanical heart valves to function without anticoagulation, a few cases are present in the literature [3, 4]. How these prosthetic heart valves were protected so long is unknown. We suppose that it depends on individual activity of coagulation and fibrinolysis.

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1. Miller MM, Hipp R, Matsumura ME. Freedom from complications related to dual ball-and-cage mechanical valve prostheses despite thirty years without anticoagulation. Interact CardioVasc Thorac Surg 2008;7:1167–1169.[Abstract/Free Full Text]
2. Dunning J, Versteegh M, Fabbri A, Pavie A, Kolh P, Lockowandt U, Nashef S. Guideline of antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008;34:73–92.[Abstract/Free Full Text]
3. Kücükaksu DS, Akgül A, Uzun A, Tarcan O, Cagli K, Sener E, Tasdemir O, Bayazit OK. Thirty years survival without anticoagulation after aortic valve replacement with a Björk-Shiley prosthesis. J Heart Valve Dis 2001;10:548–549.[Medline]
4. Yildiz A, Özcan F, Dogan M, Ozl MF, Sasmaz A. Twenty-two years without anticoagulation with metallic heart valve. J Natl Med Assoc 2006;98:1348–1349.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Kuts, E.V. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Kuts, E.V. Related Collections Related Article