Outcomes after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications.
- 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
- 2Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minn.
Abstract
Background
Conversion from mechanical to bioprosthetic valves is sometimes pursued for anticoagulation-related complications, yet outcomes after such conversion remain poorly characterized.Methods
We analyzed 62 consecutive patients undergoing mechanical-to-bioprosthetic valve replacement owing to major bleeding, recurrent thromboembolism, or nonbleeding/nonthromboembolic warfarin-related difficulty between 2000 and 2005. The primary endpoint was time to first postoperative bleeding or thromboembolic event, with death treated as a competing risk. Survival was estimated using Kaplan-Meier analysis.Results
The median interval from mechanical valve implantation to conversion was 7 years (interquartile range, 1-17 years). Fifty-eight percent of procedures were urgent or emergent, and hospital mortality was 13%. Among hospital survivors, 66% were discharged on and remained on warfarin therapy beyond 3 months. Overall survival was 82% at 1 year and 71% at 5 years. The 5-year cumulative incidence of bleeding or thromboembolism was 27%, with 63% of events occuring while patients were receiving warfarin.Conclusions
Conversion from a mechanical valve to a bioprosthetic valve for anticoagulation-related complications carries substantial early risk and frequently does not eliminate the need for anticoagulation. Recurrent bleeding and thromboembolic events remain clinically significant, underscoring the importance of careful patient counseling and shared decision making.
Related
- Anticoagulation management and valve-related outcomes after mechanical valve implantation in patients with Fontan palliation
- Mechanical Complications After Acute Myocardial Infarction: Contemporary Management, Treatment Selection, and Outcomes in a 10-Year Regional Referral Network
- Investigation of surface anticoagulation in electrically active mechanical mitral valve in swine model
- Effects of mechanical thrombectomy combined with anticoagulation vs anticoagulation monotherapy for acute intermediate-high risk pulmonary embolism: study protocol for a randomized controlled trial (CAPE study, ChiCTR2500095253, https://www.medicalresearch.org.cn/clinicalResearch/researchInfo?id=c57630b7-51ec-4b24-83e1-85b9c0a835d6).
- Intravenous thrombolysis in acute ischemic stroke after reversal of warfarin anticoagulation in patients with mechanical heart valve prostheses and an INR > 1.7
BibTeX
@article{tam2026outcomes,
title = {{Outcomes after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications.}},
author = {Vincy Tam and Hartzell V Schaff and Kevin L Greason and Richard C Daly and Alexander Lee and Austin Todd and Kimberly Holst and Juan A Crestanello},
journal = {JTCVS open},
year = {2026},
month = jun,
doi = {10.1016/j.xjon.2026.101927},
url = {https://europepmc.org/article/MED/42948435},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Outcomes after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications.
AU - Vincy Tam
AU - Hartzell V Schaff
AU - Kevin L Greason
AU - Richard C Daly
AU - Alexander Lee
AU - Austin Todd
AU - Kimberly Holst
AU - Juan A Crestanello
PY - 2026
DA - 2026/06/12
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101927
UR - https://europepmc.org/article/MED/42948435
AB - Background Conversion from mechanical to bioprosthetic valves is sometimes pursued for anticoagulation-related complications, yet outcomes after such conversion remain poorly characterized.Methods We analyzed 62 consecutive patients undergoing mechanical-to-bioprosthetic valve replacement owing to major bleeding, recurrent thromboembolism, or nonbleeding/nonthromboembolic warfarin-related difficulty between 2000 and 2005. The primary endpoint was time to first postoperative bleeding or thromboembolic event, with death treated as a competing risk. Survival was estimated using Kaplan-Meier analysis.Results The median interval from mechanical valve implantation to conversion was 7 years (interquartile range, 1-17 years). Fifty-eight percent of procedures were urgent or emergent, and hospital mortality was 13%. Among hospital survivors, 66% were discharged on and remained on warfarin therapy beyond 3 months. Overall survival was 82% at 1 year and 71% at 5 years. The 5-year cumulative incidence of bleeding or thromboembolism was 27%, with 63% of events occuring while patients were receiving warfarin.Conclusions Conversion from a mechanical valve to a bioprosthetic valve for anticoagulation-related complications carries substantial early risk and frequently does not eliminate the need for anticoagulation. Recurrent bleeding and thromboembolic events remain clinically significant, underscoring the importance of careful patient counseling and shared decision making.
SN - 2666-2736
ER -