One-Year Follow-Up of Morbidity and Mortality in Mechanical Valve Replacement Patients at a Newly Established Cardiac Center in a Developing Country

Abstract

Objective: To examine the morbidity and mortality rates associated with mechanical heart valve replacement in patients from a developing country at a 1-year follow-up.

Methodology: This retrospective observational study was conducted on the patients who presented with Aortic Valve Replacement (AVR), Mitral Valve Replacement (MVR) and Dual Valve Replacement (DVR), at the Cardiac Surgery Department of Peshawar Institute of Cardiology (PIC). The data of 258 patients who underwent these cardiac procedures was collected between a period of two years i.e., from Jan 2021 till Dec 2022 from the hospital records.

Results: Out of 258 patients, 37 (14.3%) were readmitted within one year of surgery due to complications such as pericardial effusion, pleural effusion, bleeding, endocarditis, hemorrhagic stroke, and stuck valve. The in-hospital mortality rate following the procedure was 2.7%, while the 1-year post-discharge mortality rate was 10.3%, with 14 cases (51.86%) attributed to warfarin-related complications. Within the first year after discharge, the average number of INR (International Normalized Ratio) tests conducted was 8.34 ± 8.268, and the average number of consultations for INR management was 2.53 ± 3.715.

Conclusion: Warfarin-related complications are a major contributor to mortality and morbidity in patients with mechanical heart valves in developing countries. To address this, newly established cardiac centers in the developing world should adopt innovative strategies, such as establishing dedicated warfarin clinics, promoting the use of self-testing devices, and developing remote cardiac care centers to reduce these complications.