Quadruple Valve Replacement with Mechanical Valves: An 11-Year Follow-up Study


  • Yukun Cao
  • Chunhu Gu
  • Guocheng Sun
  • Shiqiang Yu
  • Hongbing Wang
  • Dinghua Yi




Background: We performed the first quadruple valve replacement with mechanical valves, combined with the correction of complex congenital heart disease on November 17, 1999. We report here the 11-year follow-up study.

Methods: A 47-year-old man with subacute rheumatic endocarditis, a ventricular septal defect, and an obstruction of the right ventricular outflow tract required replacement of the aortic, mitral, tricuspid, and pulmonary valves; repair of the ventricular septal defect; and relief of the obstruction of the right ventricular outflow tract. The surgery was done on November 17, 1999, after careful systemic preparation of the patient. Warfarin therapy with a target international normalized ratio (INR) range of 1.5 to 2.0 was used. Follow-up included monitoring the INR, recording the incidences of thromboembolic and bleeding events, electrocardiography, radiography, and echocardiography evaluations.

Results: The patient's INR was maintained between 1.5 and 2.0. All 4 mechanical prosthetic heart valves worked well. He is in generally good health without any thromboembolic or bleeding complications.

Conclusions: Long-term management is challenging for patients who have experienced quadruple valve replacement with mechanical valves; however, promising results could mean that replacement of all 4 heart valves in 1 operation is feasible in patients with quadruple valve disease, and an INR of 1.5 to 2.0 could be appropriate for Chinese patients with undergoing valve replacement with mechanical valves.


Alsoufi B, Rao V, Borger MA, et al. 2006. Short- and long-term results of triple valve surgery in the modern era. Ann Thorac Surg 81:2172-7; discussion 2177-8.nBonow RO, Carabello BA, Kanu C, et al. 2006. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114:e84-231.nBrown PS Jr, Roberts CS, McIntosh CL, Swain JA, Clark RE. 1993. Late results after triple-valve replacement with various substitute valves. Ann Thorac Surg 55:502-8.nCannegieter SC, Rosendaal FR, Briet E. 1994. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89:635-41.nChenhsu RY, Chiang SC, Chou MH, Lin MF. 2000. Long-term treatment with warfarin in Chinese population. Ann Pharmacother 34:1395-401.nCortelazzo S, Finazzi G, Viero P, et al. 1993. Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Thromb Haemost 69:316-20.nDong L, Shi YK, Tian ZP, Ma JY, Wang X, Yi J. 2003. Low intensity anticoagulation therapy after mechanical heart valve replacement [in Chinese]. Zhonghua Wai Ke Za Zhi 41:250-2.nEitz T, Schenk S, Fritzsche D, et al. 2008. International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement. Ann Thorac Surg 85:949-54; discussion 955.nGalloway AC, Grossi EA, Baumann FG, et al. 1992. Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients. J Am Coll Cardiol 19:725-32.nGohlke-Bärwolf C, Acar J, Oakley C, et al. 1995. Guidelines for prevention of thromboembolic events in valvular heart disease. Study Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 16:1320-30.nHossack KF, Hopeman AR, Sutherland EW 3rd. 1987. Long-term follow-up of a patient with quadruple valve replacement. Tex Heart Inst J 14:315-7.nKoertke H, Zittermann A, Tenderich G, et al. 2007. Low-dose oral anticoagulation in patients with mechanical heart valve prostheses: final report from the Early Self-Management Anticoagulation Trial II. Eur Heart J 28:2479-84.nKudo T, Kawase M, Kawada S, et al. 1999. Anticoagulation after valve replacement: a multicenter retrospective study. Artif Organs 23:199-203.nLevine MN, Raskob G, Hirsh J. 1989. Hemorrhagic complications of long-term anticoagulant therapy. Chest 95:26S-36S.nLevine MN, Raskob G, Landefeld S, Kearon C. 2001. Hemorrhagic complications of anticoagulant treatment. Chest 119:108S-21S.nMori T, Asano M, Ohtake H, et al. 2002. Anticoagulant therapy after prosthetic valve replacement-optimal PT-INR in Japanese patients. Ann Thorac Cardiovasc Surg 8:83-7.nSalem DN, Stein PD, Al-Ahmad A, et al. 2004. Antithrombotic therapy in valvular heart disease-native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:457S-82S.nSeeburger J, Groesdonk H, Borger MA, et al. 2009. Quadruple valve replacement for acute endocarditis. J Thorac Cardiovasc Surg 137:1564-5.nSun X, Hu S, Qi G, Zhou Y. 2003. Low standard oral anticoagulation therapy for Chinese patients with St. Jude mechanical heart valves. Chin Med J (Engl) 116:1175-8.nUetsuka Y, Hosoda S, Kasanuki H, et al. 2000. Optimal therapeutic range for oral anticoagulants in Japanese patients with prosthetic heart valves: a preliminary report from a single institution using conversion from thrombotest to PT-INR. Heart Vessels 15:124-8.nZhou XM, Zhuang W, Hu JG, Li JM, Yu JF, Jiang L. 2005. Low-dose anticoagulation in Chinese patients with mechanical heart valves. Asian Cardiovasc Thorac Ann 13:341-4.nZhuang W, Zhou XM, Hu JG, et al. 2004. Anticoagulation in Chinese patients with Carbomedics mechanical prosthetic heart valves [in Chinese]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 29:460-2.n



How to Cite

Cao, Y., Gu, C., Sun, G., Yu, S., Wang, H., & Yi, D. (2012). Quadruple Valve Replacement with Mechanical Valves: An 11-Year Follow-up Study. The Heart Surgery Forum, 15(3), E145-E149. https://doi.org/10.1532/HSF98.20111124




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