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Journal of the American College of... Dec 2016Although surgery was the mainstay of treatment for valvular heart disease, transcatheter valve therapies have grown exponentially over the past decade. Two types of... (Review)
Review
Although surgery was the mainstay of treatment for valvular heart disease, transcatheter valve therapies have grown exponentially over the past decade. Two types of artificial heart valve exist: mechanical heart valves (MHV), which are implanted surgically, and bioprosthetic heart valves (BHV), which can be implanted via a surgical or transcatheter approach. Whereas long-term anticoagulation is required to prevent thromboembolism after MHV replacement, its value in patients receiving BHVs is uncertain. Patients undergoing transcatheter BHV replacement are at risk for thromboembolism in the first few months, and recent data suggest that the risk continues thereafter. BHV thrombosis provides a substrate for subsequent thromboembolism and may identify a reversible cause of prosthesis dysfunction. Hereafter, the authors: 1) review the data on prosthetic valve thrombosis; 2) discuss the pathophysiological mechanisms that may lead to valve thrombus formation; and 3) provide perspective on the implications of these findings in the era of transcatheter valve replacement.
Topics: Anticoagulants; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Prosthesis Failure; Thrombosis
PubMed: 27978952
DOI: 10.1016/j.jacc.2016.09.958 -
Journal of the American College of... May 2023Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can... (Review)
Review
Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation.
Topics: Humans; Thrombosis; Bioprosthesis; Heart Valve Prosthesis; Anticoagulants; Heart Valves
PubMed: 37225366
DOI: 10.1016/j.jacc.2023.03.412 -
Methodist DeBakey Cardiovascular Journal 2022Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve...
Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve disease. Paravalvular leaks result from dehiscence of the surgical ring from the mitral annulus. Some theories suggest that uneven distribution of collagen fibers in the mitral annulus leaves the posterior mitral annulus without a well-formed fibrous structure, which may predispose it to recurrent mechanical injury that leads to PVL. The reported incidence of PVL is 2.2%. Risk factors associated with PVL include the presence of mitral annular calcification, infective endocarditis, active steroid use, and continuous surgical suturing, which poses a greater risk than an interrupted surgical approach. Risk of PVL varies by prosthesis type, with mechanical prostheses carrying a higher risk of PVL than bioprosthetic valves. Below are images of a 70-year-old male with severe mitral stenosis and pulmonary hypertension who had previously undergone mitral valve commissurotomy and subsequent mitral valve replacement with a bioprosthetic mitral valve. He presented to the hospital with pulmonary edema. Initial transthoracic echocardiogram showed depressed biventricular function with a dehiscence of the bioprosthetic mitral valve and a large eccentric posterior PVL, severe tricuspid regurgitation, and severe pulmonary hypertension. Transesophageal images in illustrate a significant posterior PVL with dehiscence of the prosthetic valve from the mitral annulus. The patient underwent closure of the paravalvular leak with two 18-mm Amplatzer ventricular septal defect occluders (Abbott) with excellent results and trace residual mitral regurgitation post closure ( ).
Topics: Aged; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Male; Mitral Valve; Mitral Valve Insufficiency; Prosthesis Failure; Treatment Outcome
PubMed: 35432730
DOI: 10.14797/mdcvj.1096 -
Surgical Technology International Nov 2020Heart valve replacement is the most common cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of...
Heart valve replacement is the most common cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are the goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies are available, which should be guided by a comprehensive evaluation of the extent of the infection and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence. Conventional mechanical or stented xenografts are the preferred choice for localized heart infection. In cases of complex IE with involvement of the root or the aorto-mitral continuity, the use of homograft is suggested according to the surgeon's and center's experience. The use of homograft needs to be balanced against the risk of structural degeneration. Prosthetic bioroot and prosthetic valved conduit with a mechanical or bioprosthetic valve are also considered acceptable alternatives in patients with aortic valve endocarditis. The further development of preservation techniques to enable the longer durability of allogeneic substitutes is required. We discuss current evidence for the use of valve substitutes in heart valve endocarditis and propose an evidence-based algorithm for the choice of treatment.
Topics: Aortic Valve; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Transplantation, Homologous
PubMed: 32520388
DOI: No ID Found -
Seminars in Thoracic and Cardiovascular... 2015The lack of an ideal prosthetic heart valve leaves surgeons and their patients with a difficult choice at the time of valve replacement surgery. Current guidelines... (Review)
Review
The lack of an ideal prosthetic heart valve leaves surgeons and their patients with a difficult choice at the time of valve replacement surgery. Current guidelines mainly emphasize patient age, contraindications to anticoagulation, and patient desires in their recommendations for the type of prosthesis to implant. Aortic valve replacement is the most frequently performed valve replacement, and 5 articles in recent years have presented important data on outcomes with different prosthesis types. The findings suggest that in young patients, transvalvular prosthesis gradients have an effect on long-term bioprosthesis durability. Use of the bioprosthesis with the best hemodynamic profile for each patient may improve prosthesis longevity and negate the advantages of mechanical valves. In older patients, the new sutureless bioprostheses appear to facilitate surgical aortic valve replacement and become an alternative to transcatheter technologies in medium- to high-risk patients.
Topics: Age Factors; Aortic Valve; Bioprosthesis; Device Removal; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Patient Selection; Prosthesis Design; Prosthesis Failure; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26686441
DOI: 10.1053/j.semtcvs.2015.06.007 -
Catheterization and Cardiovascular... Feb 2022Prosthetic valve endocarditis (PVE) following transcatheter aortic valve replacement (TAVR) in low surgical risk patients is uncommon, occurring in 11 of 396 patients...
Prosthetic valve endocarditis (PVE) following transcatheter aortic valve replacement (TAVR) in low surgical risk patients is uncommon, occurring in 11 of 396 patients (2.8%) in the study by Medranda et al., but associated with high morbidity (6 of 11 with embolic strokes [55%]) and mortality (2 of 11 [18%]). As TAVR volumes increase, especially in low surgical risk patients, whose long-term outcomes are generally excellent, PVE will become an increasingly important concern. Future research is needed to identify optimal strategies for prevention, diagnosis, and treatment of PVE associated with TAVR.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35235689
DOI: 10.1002/ccd.30126 -
Journal of Cardiothoracic and Vascular... Apr 2023Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic.... (Review)
Review
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Heart Failure; Risk Factors
PubMed: 36725476
DOI: 10.1053/j.jvca.2022.12.030 -
Progress in Cardiovascular Diseases 2022Acquired valvular heart disease is associated with increased mortality and morbidity. While the etiology of the valvular dysfunction determines the mode of treatment,... (Review)
Review
Acquired valvular heart disease is associated with increased mortality and morbidity. While the etiology of the valvular dysfunction determines the mode of treatment, over 100,000 valve operations are performed annually in the US with the use of bioprosthetic valves comprising up to 90%. While bioprosthetic valves do not require life long anticoagulation, the incidence of prosthetic valve thrombosis is continuously increasing. This article reviews the current status on diagnosis, treatment modalities and management of bioprosthetic valve thrombosis.
Topics: Aortic Valve; Bioprosthesis; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombosis
PubMed: 35764124
DOI: 10.1016/j.pcad.2022.06.008 -
Progress in Cardiovascular Diseases 2022
Topics: Aortic Valve; Heart Valve Prosthesis; Humans
PubMed: 35691606
DOI: 10.1016/j.pcad.2022.06.002 -
Current Cardiology Reviews 2022Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily...
BACKGROUND
Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences.
OBJECTIVE
Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success.
METHODS
A comprehensive literature search was undertaken to formulate this narrative review.
RESULTS
This review highlights the complex nature of PVL and the promising contemporary treatments available.
CONCLUSION
Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
Topics: Humans; Aortic Valve; Aortic Valve Insufficiency; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35546743
DOI: 10.2174/1573403X18666220511113310