Journal of Cardiac Surgery | 2021
Reply: Intraoperative transesophageal echocardiography is essential for left atrial appendage closure
Abstract
To the Editor, We thank Güner et al. for their comments. We appreciate the authors for their concerns about the importance of applying transesophageal echocardiography (TEE) intraoperatively and the discussion about the strategy of postoperative oral anticoagulants. Actually, we would conduct intraoperative TEE for each patient to determine whether there is dysfunction of prosthetic or incomplete suture of the left atrial appendage. The operator will not finish the operation until TEE revealed that the prosthetic valve functions well and the left atrial appendage is completely sutured Besides, each patient was given warfarin (Orion Corporation) 2.5mg for anticoagulation therapy on Day 1 after surgery, then the international standardized ratio (INR) was monitored daily to adjust warfarin dosage. Target INR is maintained at around 2.5 according to the guideline recommendation, and heparin was given intravenously at 1mg/kg per day before the INR reached the target value. We recommend that the patient review coagulation parameters weekly at the local hospital after discharged and then adjust the warfarin dosage according to the INR results. If the results are not problematic, the interval for review should be gradually extended to once a month. Table 1 shows our experience of the anticoagulation treatment plan of patients after discharge.