Article Text

“Routine” approach to follow-up and echocardiogram after a valve replacement surgery is not a clinically effective strategy
  1. I Mahmood1,
  2. J Kallingal1,
  3. N Sabtu1,
  4. J Huish2,
  5. JR Dowdle2
  1. 1University Hospital of Wales, Cardiff, UK
  2. 2Royal Glamorgan Hospital, Cardiff, UK


Background Traditionally, all patients who have undergone a valve replacement surgery are followed up on a regular basis by cardiologists, usually annually. This follow-up assessment is usually accompanied by an echocardiogram. This practice has put an enormous demand on the outpatient and echocardiography services. Our chief objective was to assess the effectiveness of this management strategy.

Methods This was a retrospective two-centre study taking place in a tertiary cardiac centre and a district general hospital (DGH). 170 patients (144 mechanical and 26 biological valves) were included. All patients in the tertiary cardiac centre who had their surgery between 1998 and 2002, and attended a follow-up appointment in the same hospital were selected from the cardiac surgical registry (n  =  107). In order to involve the patients who had surgery earlier than 1998, we also included all prosthetic valve patients who attended the outpatient clinic of a senior cardiologist in a DGH (n = 63). The strategies of choosing patients from surgical registry, as well as random non-selective from a DGH clinic were used to minimise bias. The prosthetic valves in the DGH patients were implanted between 1966 and 2003. Documentation of these patients’ clinic visits including letters and echocardiogram reports were retrieved.

Abstract 059 Table

Results 1022 outpatient visits and 216 echocardiograms were analysed. The mean and median duration of follow-up from the valve implantation were 6.5 and 5 years, respectively. Seven patients (4.2%) developed problems with either prosthetic valves or surrounding structures between 3 and 14 years (average 8) after implantation, even though none required cardiac surgical intervention (table). Six patients (3.5%) developed clinically significant disease of the native valves during the course of follow-ups. 642 follow-ups (63%) and 184 (85%) echocardiogram examinations were classified as “routine” and without clear clinical indications.

Conclusions Routine follow-up and echocardiogram of patients after a valve replacement surgery are associated with a low yield for abnormal findings, with most problems occurred after 7 years of implantation. To avoid waste in clinical resources, the decision to follow-up these patients should be based on clinical needs. While we suggest that patients with mechanical valves do not require routine follow-up, there is a case to perform echocardiogram on the bio-prosthetic valve patients infrequently, due to the degenerative tendency of this type of valve. The number of biological prosthetic valve patients in this study is too small to draw any meaningful conclusion.

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