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Internal Medicine (Tokyo, Japan) Feb 2024
Topics: Humans; Candida; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Candidiasis; Antifungal Agents
PubMed: 37316271
DOI: 10.2169/internalmedicine.1987-23 -
Clinical Imaging Aug 2023Prosthetic heart valve (PHV) dysfunction is a serious complication. Echocardiography remains the first-line imaging investigation to assess PHV dysfunction. However, the...
BACKGROUND
Prosthetic heart valve (PHV) dysfunction is a serious complication. Echocardiography remains the first-line imaging investigation to assess PHV dysfunction. However, the role of Computed Tomography (CT) scanning in this type of case has not been thoroughly studied yet. The objective of our study was to determine if cardiac Computed Tomography (CT) had a potentially complementary role to play alongside echocardiography in diagnosing the mechanism of prosthetic valve dysfunction.
METHODS AND RESULTS
This prospective cohort study was conducted on 54 patients with suspected PHV dysfunction. All patients underwent routine diagnosis work-up (transthoracic and transesophageal echocardiography) and additional cardiac CT. Cardiac CT showed findings that were not detected by echocardiography in seven patients (12%) namely aortic pannus (5) and pseudoaneurysm (2). An underlying thrombus was detected by echocardiography and missed by cardiac CT in 15 patients (27%). However, in these thrombotic cases, cardiac CT contributed to the functional evaluation of leaflets.
CONCLUSION
This study demonstrates that an integrated approach including transthoracic, transesophageal echocardiography and computed tomography is useful in patients with suspected PHV dysfunction. While computed tomography is more accurate in the diagnosis of pannus formation and periannular complications, echocardiography is superior at detecting thrombus.
Topics: Humans; Heart Valve Prosthesis; Prospective Studies; Tomography; Echocardiography, Transesophageal; Thrombosis; Heart Valves; Prosthesis Failure
PubMed: 37146521
DOI: 10.1016/j.clinimag.2023.02.011 -
Annals of Biomedical Engineering Feb 2017Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart... (Review)
Review
Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch. In this article, we provide an in-depth review of the current state-of-the-art pertaining the mechanics of TAVs while highlighting various studies guiding clinicians, regulatory agencies, and next-generation device designers.
Topics: Animals; Heart Valve Prosthesis; Humans; Prosthesis Design; Transcatheter Aortic Valve Replacement
PubMed: 27873034
DOI: 10.1007/s10439-016-1759-3 -
BJOG : An International Journal of... Oct 2015Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes.
OBJECTIVES
Systematic review to assess risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) over the last 20 years.
SEARCH STRATEGY
Electronic literature search of Medline, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and Embase to find recent studies.
SELECTION CRITERIA
Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series.
DATA COLLECTION AND ANALYSIS
Primary analysis calculated absolute risks and 95% confidence intervals (CI) for pregnancy outcomes using a random effects model. The Freeman-Tukey transformation was utilised in secondary analysis due to the large number of individual study outcomes with zero events.
MAIN RESULTS
Eleven studies capturing 499 pregnancies among women with heart valve prostheses, including 256 mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2), for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100 pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI 1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5).
CONCLUSIONS
Women with heart valve prostheses experienced higher rates of adverse outcomes than expected in a general obstetric population; however, lower than previously reported. Women with bioprostheses had significantly fewer thromboembolic events compared to women with mechanical valves. Women should be counselled pre-pregnancy about risk of maternal death and pregnancy loss. Vigilant surveillance by a multidisciplinary team throughout the perinatal period remains warranted for these women and their infants.
TWEETABLE ABSTRACT
Metaanalysis suggests improvement in #pregnancy outcomes among women with #heartvalveprostheses.
Topics: Bioprosthesis; Female; Fetal Death; Fetal Mortality; Heart Valve Prosthesis; Humans; Infant, Newborn; Maternal Mortality; Perinatal Mortality; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Thromboembolism
PubMed: 26119028
DOI: 10.1111/1471-0528.13491 -
Current Opinion in Infectious Diseases Dec 2021Current evidence on cardiovascular infections in Gram-negative blood stream infections (GNBSI) with focus on the use of transesophageal echocardiography (TEE) and... (Review)
Review
PURPOSE OF REVIEW
Current evidence on cardiovascular infections in Gram-negative blood stream infections (GNBSI) with focus on the use of transesophageal echocardiography (TEE) and 18F-Fluorodeoxyglucose - positron emission tomography/Computed tomography (FDG-PET/CT) in the diagnostic workup.
RECENT FINDINGS
Most evidence focuses on characteristics of diagnosed cardiovascular infections and the proportion caused by GNBSI. These proportions are low (1-5%) when it comes to native and prosthetic valve endocarditis as well as cardiac implantable electronic device (CIED) infections whereas the proportion of vascular graft infections caused by GNBSI seems substantially higher (30-40%). Information on the prevalence of cardiovascular infection in patients with GNBSI is limited to a few studies finding around 3% endocarditis in patients with GNBSI and a prosthetic heart valve and 4-16% device-related infection in patients with CIED and GNBSI.
SUMMARY
Patients with GNBSI and native or prosthetic valves should only undergo work-up for endocarditis (TEE and FDG-PET/CT) if they present GNBSI relapse or signs suggestive of endocarditis. CIED patients with GNBSI with Pseudomonas or Serratia spp. should undergo TEE and PET/CT because of the high prevalence of device-related infection. In other GNBs without IE suggestive signs, normal BSI treatment is reasonable and only cases with relapse need work-up. GNBSI in patients with vascular grafts should lead to consideration of PET/CT.
Topics: Bacteremia; Echocardiography; Endocarditis; Endocarditis, Bacterial; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 34751186
DOI: 10.1097/QCO.0000000000000781 -
Multimedia Manual of Cardiothoracic... Apr 2023Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with...
Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with mitral and tricuspid procedures, aortic valve operations increase the challenge for several reasons. If one relies only on the thoracoscope, the surgical planning and set-up, including the placement of the working port and technical surgical manoeuvres like the aortic cross-clamp, the aortotomy and the aortorrhaphy can be difficult and may lead to severe complications or an increased rate of conversion to sternotomy. A well-developed preoperative decision-making process that includes knowledge of the prosthetic valve characteristics and their implications in an endoscopic environment is crucial for a successful endoscopic aortic valve programme. This video tutorial provides tips and tricks useful for endoscopic aortic valve replacement by paying attention to the patient's anatomy, to the available prosthetic valve types and to their impact on the surgical set-up.
Topics: Humans; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Endoscopy; Minimally Invasive Surgical Procedures
PubMed: 37009910
DOI: 10.1510/mmcts.2023.007 -
Journal of Cardiac Surgery Sep 2022Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The choice between surgery and FT has always been a matter of debate. Previous studies have shown that although the mortality rate is higher in surgery, complications are less frequent than in FT. We aimed to perform a systematic review and meta-analysis to compare the results of surgery and FT in PVT.
METHODS
A systematic review of the literature was performed through Medline, Embase, Scopus, and Web of Science, encompassing all studies comparing surgery and FT in PVT. The rate of each complication and risk ratio (RR) of complications in surgery and FT were assessed using random-effects models.
RESULTS
Fifteen studies with 1235 patients were included in the meta-analysis. The pooled risk of the mortality was not significantly different between FT and surgery in patients with PVT (pooled RR = 0.78, 95% confidence interval [CI]: 0.38-1.60, I² = 61.4%). The pooled risks of thromboembolic events (pooled RR = 4.70, 95% CI: 1.83-12.07, I² = 49.6%) and major bleeding (pooled RR = 2.45, 95% CI: 1.09-5.50, I² = 41.1%) and PVT recurrence (pooled RR = 2.06 95% CI: 1.29-3.27, I² = 0.0%) were significantly higher in patients who received FT.
CONCLUSION
Surgery may be safer and with fewer complications than FT for PVT treatment. However, randomized clinical trials are needed to determine the proper treatment for PVT.
Topics: Fibrinolytic Agents; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombolytic Therapy; Thrombosis
PubMed: 35701901
DOI: 10.1111/jocs.16681 -
Current Opinion in Cardiology Mar 2016The efficacy of anticoagulation for valvular prostheses is the result of a delicate balance between the risk of thromboembolic (TE) events and bleeding. Here, we review... (Review)
Review
PURPOSE OF REVIEW
The efficacy of anticoagulation for valvular prostheses is the result of a delicate balance between the risk of thromboembolic (TE) events and bleeding. Here, we review data on anticoagulation for valve prostheses with a focus on clinical trials that address key unanswered questions.
RECENT FINDINGS
There are several unanswered questions in the field of prosthetic valve anticoagulation, including: optimal TE prophylaxis in the short term for bioprostheses, optimal TE prophylaxis following transcatheter aortic valve implantation, the safety and efficacy of lower levels of anticoagulation with the bileaflet mechanical prosthesis, the role of aspirin for patients with mechanical prostheses, and the management of anticoagulation for mechanical valves in pregnancy. Other areas of study include the role, if any, of nonwarfarin oral anticoagulants for prosthetic TE prophylaxis as well as self-INR monitoring. Finally, we briefly mention studies of newer anticoagulants, such as novel vitamin K antagonists and antisense oligonucleotides, that are on the horizon.
SUMMARY
Optimal antithrombotic management is a key issue for patients with valvular prostheses, and the publication of recent trials has provided much-needed guidance. We highlight areas of progress, in addition to the major unanswered questions for which well-designed, prospective clinical trials are forthcoming.
Topics: Chemoprevention; Fibrinolytic Agents; Heart Valve Prosthesis; Hemorrhage; Humans; Risk Adjustment; Thromboembolism
PubMed: 26731290
DOI: 10.1097/HCO.0000000000000259 -
Expert Review of Medical Devices Mar 2020: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there... (Review)
Review
: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.: The etiopathogenesis, diagnosis, and management of prosthetic heart valve thrombosis with particular focus on conventional and esoteric predisposing factors, diagnosis with multimodality imaging and current therapeutic approaches were covered.: Subtherapeutic anticoagulation remains the key driving force for the development of prosthetic valve thrombosis. However, cardiologists should be cognizant of other frequent or rare conventional and esoteric causes. The diagnosis is now more straightforward with the use of multimodality imaging. Transthoracic and transesophageal echocardiography with or without real-time three-dimensional imaging are the current gold standard modalities. Multidetector computed tomography is now a major complementary tool. The favorable clinical outcomes with recently introduced slow or ultra-slow infusions of alteplase, as compared to relatively poor surgical results, have rendered thrombolytic therapy the first-line treatment option in most eligible patients with prosthetic valve thrombosis. Surgical treatment could be reserved in whom thrombolytic therapy is contraindicated or has already failed. The efficacy and safety of thrombolytic therapy as compared to surgery should be confirmed with large observational cohorts, and ideally randomized trials.
Topics: Echocardiography, Transesophageal; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator
PubMed: 32085683
DOI: 10.1080/17434440.2020.1733972 -
Journal of Cardiac Surgery May 2022Surgical aortic valve replacement (sAVR) remains one of the most common cardiac operations performed globally on an annual basis. Biological and mechanical valves...
Surgical aortic valve replacement (sAVR) remains one of the most common cardiac operations performed globally on an annual basis. Biological and mechanical valves comprise the two classes of prosthetic valves available to surgeons. Biological prosthetic valves can be prone to failure and structural valve deterioration (SVD), which may necessitate reintervention. Recent literature suggests that the Trifecta heart valve is susceptible to early failure. In this retrospective study, Yount et al. use institutional data to assess the longevity of the Trifecta heart valve. The investigators included patients who had undergone sAVR and had received either a Trifecta prosthetic heart valve or a Magna/Magna Ease heart valve. While there were some baseline differences between the patient groups, the study found that those who had received a Trifecta valve had higher rates of valve failure. This is an important study that adds valuable evidence pertaining to the incidence of failure and SVD with the Trifecta heart valve. Although further studies may shed light on the precise mechanisms that drive valve failure and deterioration, surgeons should be aware of the mounting clinical data in this area.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Retrospective Studies; Treatment Outcome
PubMed: 35152477
DOI: 10.1111/jocs.16325