Inr normal range mechanical valve9/10/2023 Literature search was carried out electronically in the medical search engine “PubMed” and Google Scholar for relevant reports published between 1990 and October 2017. The current Good Clinical Practice Recommendations (GCPR) from the IACTS for the follow-up and management of VHD patients with a prosthetic valve in India is developed by an “expert panel” of cardiologists and cardiothoracic surgeons across the country with vast experience in managing prosthetic valve patients.Ī national panel with 13 members reviewed the literature and collected the evidence. Nonetheless, the efficacy of anticoagulants in patients with valve repair needs to be confirmed in randomized controlled trials (RCTs). Anticoagulation therapy has no extra advantage over antiplatelet therapy in valve repair patients, and anticoagulation therapy may lead to major bleeding complications. Management of patients with valve repair necessitates antithrombotic therapy for the first 3 months following surgery, which is a high-risk period for thromboembolism. Furthermore, evidence indicates that along with short-term benefit, patients with valve repair also have an extra advantage toward the long-term survival compared to valve replacement patients. Valve repair surgery has some short-term advantages such as minimal morbidity and mortality, better survival, superior preservation of left ventricular (LV) function, and less valve-related complications over valve replacement surgery. Additionally, the repair rate among the elderly has remained much lower than their younger counterparts. However, this rate is still much lower than the 90% or higher rates achieved by some institutions. Globally, valve repair rate for isolated mitral valve disease from 2000 to 2007 has increased from 51 to 69%. This increase may be attributed to increasing rate of valve replacement surgery in the elderly, in whom bioprosthetic is preferred, and to technological advances in bioprosthesis compared to mechanical device development. Globally, the prosthetic valve implantations are increasing at a rate of 5–7% per year with bioprosthesis valves gaining favor over mechanical heart valves 8–11% versus 3–5% per year respectively. In India, this number is estimated to be in excess of 10,000. The worldwide annual rate of valve replacement is projected around 275,000 to 370,000, of which 55% are mechanical heart valves and 45% are bioprosthesis heart valves. Surgical valve repair or replacement using either a mechanical or bioprosthetic valve is a common solution practiced globally to manage or treat VHD. This pattern of VHD in India is in contrast to the developed countries, where the most frequently involved valve type is aortic with degenerative etiology. Overall, RHD contributes 63.4% to the prevalence of VHD. The pattern of valve involvement is mitral (54.4%), aortic (17.8%), both mitral and aortic (18.0%), tricuspid (9.7%), or pulmonary (0.04%). Data on the burden of RHD in India comes from hospital data (20–50%), population-based studies (2.2–1.6%), and school surveys (0.67–4.54%). Prevalence of VHD in industrialized countries is estimated at 2.5%. The burden of VHD is growing worldwide due to the high incidence of rheumatic heart disease (RHD), especially in developing countries, and due to the increase in degenerative etiologies in industrialized nations. Valvular heart disease (VHD) is one of the common causes of cardiac morbidity and mortality.
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