Atrial Fibrillation and Mitral Valve Repair

Angelika Jovin, MD; Dana A. Oprea, MD; Ion S. Jovin, MD; Sabet W. Hashim, MD; Jude F. Clancy, MD

Disclosures

Pacing Clin Electrophysiol. 2008;31(8):1057-1063. 

In This Article

Anticoagulation for AF and Mitral Valve Repair

Although the utility of warfarin in the postoperative management of mechanical valve replacement is well established, anticoagulation following bioprosthetic valve replacement and valve repair is a subject of controversy.[78] The management initially described by Carpentier was to anticoagulate all patients with warfarin for a period of 2 months postoperatively. Unfortunately, an INR range was not reported. After a 10-year follow-up, Carpentier reported a thromboembolic rate of 0.6% per patient-year, of which all episodes were transient, even though 48% of the patients had been without anticoagulation since the end of the 2-month period.[79] Patients undergoing mitral valve repair are often discharged on oral anticoagulation with warfarin. The decision regarding oral anticoagulation at the time of discharge from the hospital depends on the presence of AF, which represents the only well-documented indication for oral anticoagulation in these patients. A study of 245 patients who underwent mitral valve repair assessed the incidence of AF after mitral valve repair and found that only a relatively small proportion of the studied patients were in AF at discharge after mitral valve repair, especially patients with AF on admission, with larger atria and with a history of ACE inhibitors use. Patients with none of these risk factors were at low risk for AF at discharge after mitral repair.[80] Recent reports suggest that for patients who have no history of AF and are not in AF after mitral repair, anticoagulation practices vary widely,[81] but recent European Society of Cardiology guidelines recommend 3 months of anticoagulation.[82]

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