Living with prosthetic heart valves. Subsequent noncardiac operations and the risk of thromboembolism or hemorrhage.

A total of 111 survivors of prosthetic valve insertion were followed an average of 4 years to assess the risk of thromboembolism or hemorrhage. Non-cloth-covered ball and/or disc valve prostheses were used, and all patients received long-term anticoagulant therapy. During the follow-up period the patients with mitral or combined valve replacement suffered four times more thromboembolic episodes and had a poorer survival rate than the patients with isolated aortic valve replacement. The management of anticoagulation and the complications resulting from 44 subsequent noncardiac operations were analyzed. Anticoagulation was discontinued before 25 noncardiac operations in patients with isolated aortic valve prostheses and there were no perioperative thromboemboli. Ten operations were performed on patients with mitral or combined valve prostheses with cessation of anticoagulation prior to surgery and there were two deaths due to perioperative thromboemboli. Unanticipated hemorrhage was encountered in four of nine patients in whom anticoagulation was maintained during surgery. Cessation of anticoagulation for 3 to 5 days appears safe in patients with aortic prostheses who require subsequent noncardiac operations. The incidence of thromboembolism in patients after mitral or combined valve replacement is high and constitutes a major risk whether or not a subsequent operation is required.