-
International Journal of Clinical... Oct 2014Heart valve replacements improve symptoms and life expectancy but may have potential problems. Biological replacements have limited durability but do not require...
Heart valve replacements improve symptoms and life expectancy but may have potential problems. Biological replacements have limited durability but do not require anticoagulation and are usually used for the relatively elderly. Mechanical valves have a virtually zero primary failure rate but require anticoagulation and are usually used for the relatively younger patient. Transcatheter valves are used for patients in whom conventional surgery is not technically feasible or who have significant comorbidities. This article discusses the management of patients after valve replacement and discusses future developments.
Topics: Contraindications; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Heterografts; Humans
PubMed: 24423099
DOI: 10.1111/ijcp.12309 -
Journal of Cardiac Surgery Dec 2020The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature.... (Review)
Review
BACKGROUND
The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature. Antithrombotic therapies are used after heart valve intervention to reduce the rates of thromboembolic events, therefore improving patient outcomes. Different interventions may require different therapeutic regimens to achieve the most efficacious clinical outcome for patients.
METHODS AND DISCUSSION
This review aims to summarize and critique the available literature concerning therapeutic agents used for bioprosthetic and mechanical valves as well as for valve repair, so as to assist clinicians and researchers in making decisions with regard to their patients and research endeavors.
Topics: Anticoagulants; Heart Valve Prosthesis; Humans; Platelet Aggregation Inhibitors; Thromboembolism
PubMed: 32939828
DOI: 10.1111/jocs.15034 -
Anatolian Journal of Cardiology Dec 2016Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of... (Review)
Review
Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of prosthetic valve thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical prosthetic valve thrombosis.
Topics: Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Humans; Mitral Valve; Thrombolytic Therapy; Thrombosis
PubMed: 28005024
DOI: 10.14744/AnatolJCardiol.2016.7486 -
Current Cardiology Reports Oct 2022Paravalvular leak (PVL) is a relatively uncommon complication associated with prosthetic valve implantation. PVL can occasionally lead to serious adverse consequences... (Review)
Review
PURPOSE OF REVIEW
Paravalvular leak (PVL) is a relatively uncommon complication associated with prosthetic valve implantation. PVL can occasionally lead to serious adverse consequences such as congestive heart failure, infective endocarditis, and hemolytic anemia. Surgical re-operation carries a high mortality risk.
RECENT FINDINGS
Transcatheter closure therapy provides a viable alternative for the treatment of this disorder with reasonable procedural and clinical success. The recent advent of hybrid imaging modalities has increased procedural success. This article summarizes the pathophysiology, clinical characteristics, and treatment modalities surroundings prosthetic paravalvular leak.
Topics: Cardiac Catheterization; Heart Failure; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Failure; Reoperation; Treatment Outcome
PubMed: 36152141
DOI: 10.1007/s11886-022-01744-y -
Journal of the American College of... Apr 2019Prosthetic heart valve interventions continue to evolve with new innovations in surgical and transcatheter technologies. We compared the recommendations from the 2017... (Comparative Study)
Comparative Study Review
Prosthetic heart valve interventions continue to evolve with new innovations in surgical and transcatheter technologies. We compared the recommendations from the 2017 American College of Cardiology/American Heart Association guidelines for management of patients with prosthetic heart valves with the 2017 European Society of Cardiology guidelines. The 2 documents differed regarding recommendations for follow-up imaging, the choice of biological versus mechanical prosthesis, bridging therapies, role of aspirin, use of fibrinolytic therapy for prosthetic valve thrombosis, and management of paravalvular regurgitation. This review highlights the differences between the 2 guidelines, summarizes new evidence, and offers recommendations for the management of patients with prosthetic heart valves in these areas of controversy.
Topics: Aftercare; Bioprosthesis; Fibrinolytic Agents; Heart Valve Prosthesis; Humans; Postoperative Complications; Practice Guidelines as Topic; Thrombosis
PubMed: 30947924
DOI: 10.1016/j.jacc.2019.01.038 -
Current Opinion in Cardiology Mar 2020A thorough understanding of the modes of bioprosthetic valve failure is critical as clinicians will be facing an increasing number of patients presenting with failed... (Review)
Review
PURPOSE OF REVIEW
A thorough understanding of the modes of bioprosthetic valve failure is critical as clinicians will be facing an increasing number of patients presenting with failed bioprostheses in coming years. The purpose of this article is to review modes of bioprosthestic valve degeneration, their management, and identify gaps for future research.
RECENT FINDINGS
Guidelines recommend monitoring hemodynamic performance of prosthetic valves using serial echocardiograms to determine valve function and presence of valve degeneration. Modes of bioprosthetic valve failure may be categorized as structural degeneration (calcification, tears, fibrosis, flail), nonstructural degeneration (pannus), thrombosis, and endocarditis. Calcification is the most common form of structural valve degeneration. Predictors of bioprosthetic valve failure include valves implanted in the mitral position, younger age, and type of valve (porcine versus bovine pericardial). Failed bioprosthetic valves are managed with either redo surgical replacement or transcatheter valve-in-valve implantation.
SUMMARY
Several modes of bioprosthetic valve failure exist, which vary based on patient, implant position, and valve characteristics. Further research is required to characterize factors associated with early failure to delay structural valve degeneration and improve patient prognosis.
Topics: Animals; Aortic Valve; Bioprosthesis; Calcinosis; Cattle; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Failure; Swine
PubMed: 31972604
DOI: 10.1097/HCO.0000000000000711 -
Circulation. Cardiovascular Imaging Sep 2015Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the... (Review)
Review
Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as new potential imaging modalities for valve prostheses. We present an overview of the possibilities and pitfalls of CT and MRI for PHV assessment based on a systematic literature review of all experimental and patient studies. For this, a comprehensive systematic search was performed in PubMed and Embase on March 24, 2015, containing CT/MRI and PHV synonyms. Our final selection yielded 82 articles on surgical valves. CT allowed adequate assessment of most modern PHVs and complemented echocardiography in detecting the obstruction cause (pannus or thrombus), bioprosthesis calcifications, and endocarditis extent (valve dehiscence and pseudoaneurysms). No clear advantage over echocardiography was found for the detection of vegetations or periprosthetic regurgitation. Whereas MRI metal artifacts may preclude direct prosthesis analysis, MRI provided information on PHV-related flow patterns and velocities. MRI demonstrated abnormal asymmetrical flow patterns in PHV obstruction and allowed prosthetic regurgitation assessment. Hence, CT shows great clinical relevance as a complementary imaging tool for the diagnostic work-up of patients with suspected PHV obstruction and endocarditis. MRI shows potential for functional PHV assessment although more studies are required to provide diagnostic reference values to allow discrimination of normal from pathological conditions.
Topics: Echocardiography; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Humans; Magnetic Resonance Imaging, Cine; Multimodal Imaging; Tomography, X-Ray Computed
PubMed: 26353926
DOI: 10.1161/CIRCIMAGING.115.003703 -
Journal of Cardiology Feb 2019Prosthetic valve endocarditis (PVE) represents a rare and serious complication of valve replacement associated with high morbidity and mortality, which significantly... (Review)
Review
Prosthetic valve endocarditis (PVE) represents a rare and serious complication of valve replacement associated with high morbidity and mortality, which significantly differs from native valve endocarditis (NVE). There are two major problems: establishing diagnosis and treatment of PVE. Diagnosis in PVE is challenging and often requires several imaging methods besides standard microbiological analyzes. Transesophageal echocardiographic examination remains the widely used imaging technique in PVE diagnosis, but additional techniques such as computed tomography (CT) and F-fluodeoxyglucose positron emission tomography/CT are often necessary. Persistent fever, embolic complications, valve dehiscence, intracardial abscess, heart failure, as well as staphylococcal and fungal PVE require surgical treatment to avoid lethal outcome. The introduction of transcatheter valve implantations and devices significantly complicated the approach - diagnostic and therapeutic to PVE patients. Despite constantly increasing knowledge regarding pathogenesis and treatment of PVE, the optimal therapy remains a matter of debate. Additional studies are necessary to define therapeutic strategies for this potentially fatal complication.
Topics: Aged; Echocardiography, Transesophageal; Endocarditis; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Tomography, X-Ray Computed
PubMed: 30389305
DOI: 10.1016/j.jjcc.2018.08.007 -
Surgery Today Apr 2022Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the... (Review)
Review
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
Topics: Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Humans; Japan; Prosthesis Design
PubMed: 34435247
DOI: 10.1007/s00595-021-02361-y -
Annals of Cardiac Anaesthesia 2022Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting... (Review)
Review
Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting for pregnancies after having PHV. All patients with PHV present unique challenges for the anesthesiologists, surgeons and obstetricians (in case of deliveries). They have to deal with the perioperative management of anticoagulation and a host of other issues involved. We reviewed the English language medical literature relevant to the different aspects of perioperative management of patients with PHV, particularly the guidelines of reputed societies that appeared in the last 20 years. Regression of cardiac pathophysiology following valve replacement is variable both in extent and timeline. The extent to which reverse remodeling occurs depends on the perioperative status of the heart. We discussed the perioperative assessment of patients with PHV, including focused history and relevant investigations with the inferences drawn. We examined the need for prophylaxis against infective endocarditis and management of anticoagulation in such patients in the perioperative period and the guidelines of reputed societies. We also reviewed the conduct of anesthesia, including general and regional anesthesia (neuraxial and peripheral nerve/plexus blocks) in such patients. Finally, we discussed the management of delivery in this group of high-risk patients. From the discussion of different aspects of perioperative management of patients with PHV, we hope to guide in formulating the comprehensive plan of management of safe anesthesia in such patients.
Topics: Anticoagulants; Endocarditis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Pregnancy
PubMed: 35799551
DOI: 10.4103/aca.aca_109_21