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The Annals of Thoracic Surgery Mar 2017Prosthetic valve endocarditis (PVE) is associated with significant morbidity, and the optimal treatment strategy has not been clearly defined. A systematic review and... (Meta-Analysis)
Meta-Analysis Review
Prosthetic valve endocarditis (PVE) is associated with significant morbidity, and the optimal treatment strategy has not been clearly defined. A systematic review and meta-analysis of 32 studies comparing valve reoperation and medical therapy was performed; it included 2,636 patients, with a mean follow-up of 22 months. A valve reoperation was associated with a lower risk of 30-day mortality, greater survival at follow-up, and a similar rate of PVE recurrence. Prospective studies are warranted to confirm these findings and to clarify clinical decision-making regarding the timing and necessity of a valve reoperation, as opposed to treatment with medical therapy alone.
Topics: Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections; Reoperation
PubMed: 28168964
DOI: 10.1016/j.athoracsur.2016.09.083 -
Regenerative Medicine Mar 2023Structural valvular deterioration of xenogenic heart valve replacements is thought to be due to a chronic immune response. We sought to engineer porcine extracellular...
Structural valvular deterioration of xenogenic heart valve replacements is thought to be due to a chronic immune response. We sought to engineer porcine extracellular matrix that elicits minimal inflammatory immune response. Whole blood, bone marrow and pericardium were collected from patients undergoing elective cardiac surgery. Porcine extracellular matrix was decellularized, reseeded with homologous mesenchymal stem cells and exposed to whole blood. DAPI stain confirmed the absence of cells after decellularization, and presence of mesenchymal stem cells after recellularization. There was a significant reduction in IL-1β and TNF-α production in the recellularized matrix. Recellularization of porcine matrix is successful at attenuating the xenogenic immune response and may provide a suitable scaffold to address the current limitations of prosthetic heart valve replacements.
Topics: Animals; Swine; Tissue Engineering; Heart Valve Prosthesis; Extracellular Matrix; Cells, Cultured
PubMed: 36691822
DOI: 10.2217/rme-2022-0172 -
Clinical Infectious Diseases : An... May 2021Prosthetic valve endocarditis (PVE) is a major infectious disease problem due to the increasing numbers of patients undergoing valve replacement surgery. PVE can present...
Prosthetic valve endocarditis (PVE) is a major infectious disease problem due to the increasing numbers of patients undergoing valve replacement surgery. PVE can present diagnostic difficulties echocardiographically, especially when complicating transvascular placement techniques. Moreover, outbreaks of unusual PVE pathogens, such as Mycobacterium chimaera, have presented major diagnostic and therapeutic dilemmas.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Mycobacterium; Prosthesis-Related Infections
PubMed: 33458755
DOI: 10.1093/cid/ciab036 -
The Journal of Invasive Cardiology Apr 2021A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis...
A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis presented to the emergency department with a history of recurrent palpitations. A transthoracic echocardiogram was performed and falsely indicated a diagnosis of prosthetic mitral valve thrombosis. However, review of the echocardiogram by an experienced echocardiologist revised the diagnosis to microbubbles formation phenomenon with mechanical mitral prosthesis. Frame-by-frame analysis or reducing the frame rate of the recorded echocardiographic loop is vital to demonstrate the growing or dissipation of microbubbles and hence to avoid inadvertent thrombolytic therapy or surgical intervention.
Topics: Adult; Female; Heart Valve Prosthesis; Humans; Microbubbles; Mitral Valve; Thrombolytic Therapy; Thrombosis
PubMed: 33794483
DOI: No ID Found -
Cardiovascular Research Mar 2023Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence... (Review)
Review
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci, and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent, and frequently, false-negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal, and viral pathogens in blood and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Staphylococcal Infections; Echocardiography
PubMed: 35420122
DOI: 10.1093/cvr/cvac055 -
International Journal of Surgery... Nov 2023Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in...
BACKGROUND
Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in the use of bioprostheses in younger patients. However, discussion of prosthetic valve selection in dialysis patients remains scarce as the guidelines are updated. This study aims to compare long-term outcomes between propensity score-matched cohorts of dialysis patients who underwent primary aortic valve replacement with a mechanical prosthesis or a bioprosthesis.
MATERIALS AND METHODS
Longitudinal data of dialysis patients who underwent primary aortic valve replacement between 1 January 2001 and 31 December 2018, were retrieved from the National Health Insurance Research Database.
RESULTS
A total of 891 eligible patients were identified, of whom 243 ideally matched pairs of patients were analyzed. There was no significant difference in all-cause mortality (hazard ratio 1.11, 95% CI: 0.88-1.40) or the incidence of major adverse prosthesis-related events between the two groups (hazard ratio 1.03, 95% CI: 0.84-1.25). In patients younger than 50 years of age, using a mechanical prosthesis was associated with a significantly longer survival time across 10 years of follow-up than using a bioprosthesis (restricted mean survival time) at 10 years: 7.24 (95% CI: 6.33-8.14) years for mechanical prosthesis versus 5.25 (95% CI: 4.25-6.25) years for bioprosthesis, restricted mean survival time difference 1.99 years, 95% CI: -3.34 to -0.64).
CONCLUSION
A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. The authors suggest mechanical prostheses for aortic valve replacement in these younger patients.
Topics: Humans; Child; Aortic Valve; Heart Valve Prosthesis Implantation; Retrospective Studies; Treatment Outcome; Prosthesis Design; Renal Dialysis; Heart Valve Prosthesis; Bioprosthesis; Reoperation
PubMed: 37526125
DOI: 10.1097/JS9.0000000000000611 -
Neurology India 2023
Topics: Humans; Heart Valve Prosthesis; Anticoagulants; Heart Valves
PubMed: 38174484
DOI: 10.4103/0028-3886.391345 -
Current Problems in Cardiology Nov 2022Nonetheless, in principle, bioprosthetic heart valves are often preferred to mechanical valves in that not only do they obviate the need for high-level systemic... (Review)
Review
Nonetheless, in principle, bioprosthetic heart valves are often preferred to mechanical valves in that not only do they obviate the need for high-level systemic anticoagulation and the attendant bleeding risks, but also higher rates of prosthetic valve thrombosis have been reported observed in the tricuspid position. The transcatheter tricuspid valve-in-valve (TVIV) procedure has expanded the horizons of cardiac surgery by allowing the implantation of stent-valves within degenerated bioprostheses in older adults and even young patients as the reported rate of the mortality of redo surgery in antecedent studies is at least 37%. Fluoroscopic guidance can assist the operator in implanting a bioprosthetic valve by radiopaque findings in the ideal position and depth; nonetheless, the complete radiolucency of some bioprosthetic valves represents a significant hurdle. In this state-of-the-art manuscript, we decided to deeply explain the appropriate heart-team approach in this scenario.
Topics: Aged; Anticoagulants; Aortic Valve; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Prosthesis Failure; Treatment Outcome; Tricuspid Valve
PubMed: 34902393
DOI: 10.1016/j.cpcardiol.2021.101081 -
Medicina (Kaunas, Lithuania) Dec 2021Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially... (Review)
Review
Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.
Topics: Echocardiography; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans
PubMed: 35056331
DOI: 10.3390/medicina58010023 -
Journal of the American College of... May 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Treatment Outcome; Risk Factors; Heart Valve Prosthesis Implantation
PubMed: 37100484
DOI: 10.1016/j.jacc.2023.03.006