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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 -
Circulation Jun 2011
Review
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Humans; Male; Middle Aged
PubMed: 21646507
DOI: 10.1161/CIRCULATIONAHA.110.979518 -
WMJ : Official Publication of the State... 2002Valvular heart disease represents a significant burden to patients with cardiovascular diseases. Surgical treatment of diseased heart valves represents a significant... (Review)
Review
BACKGROUND
Valvular heart disease represents a significant burden to patients with cardiovascular diseases. Surgical treatment of diseased heart valves represents a significant advancement for these patients. However, there are specific complications related to prosthetic valves, including valve thrombosis.
METHODS
Review article.
RESULTS
Thrombosis of a prosthetic heart valve can present with gradual cardiac decline, embolic phenomena, or frank cardiogenic shock. The diagnosis of prosthetic valve thrombosis is by history, physical examination, and by an imaging modality. Treatment of the thrombosed valve is either surgical or with thrombolysis. Both modalities have significant morbidity and mortality.
CONCLUSION
Treatment of valvular heart disease does not remove the patient from significant risks. Inherent to a prosthetic heart valve is the risk for valvular thrombosis. Prompt recognition and treatment of prosthetic valve thrombosis is important.
Topics: Heart Valve Prosthesis; Humans; Risk Factors; Thrombolytic Therapy; Thrombosis
PubMed: 12426925
DOI: No ID Found -
Journal of the American College of... Nov 2013Obstructive thrombosed prosthetic heart valve (OTPHV) is a serious complication of heart valve replacement. There are no generally accepted criteria for management of... (Review)
Review
Obstructive thrombosed prosthetic heart valve (OTPHV) is a serious complication of heart valve replacement. There are no generally accepted criteria for management of these patients. Therefore, in September 2012, a literature survey of studies published after 1995 was performed to analyze the data regarding clinical outcomes of patients with OTPHV treated with thrombolytic agents and with surgery since 1996. The search yielded appropriate and relevant studies, which included 17 studies comprising 756 patients who had received thrombolytic therapy and 13 studies comprising 662 patients who had received surgery. The data on these 2 groups was analyzed in detail relating to frequency of use of the diagnostic studies, baseline patient data, and on the rate of complete success, outcomes, and complications of the therapy they had received, and the limitations of the studies. We have then developed a strategy for therapy of OTPHV.
Topics: Echocardiography, Transesophageal; Fibrinolytic Agents; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Mitral Valve; Prosthesis Failure; Thrombolytic Therapy; Thrombosis
PubMed: 23994405
DOI: 10.1016/j.jacc.2013.07.075 -
Emergency Medicine Clinics of North... Aug 1994There are tens of thousands of patients with prosthetic heart valves implanted today, and although complications are infrequent, this may not hold true as patients live... (Review)
Review
There are tens of thousands of patients with prosthetic heart valves implanted today, and although complications are infrequent, this may not hold true as patients live longer with prosthetic valves and as more and newer valves are implanted. A familiarity with the management of such patients will aid the emergency physician in the evaluation of this increasing population of patients and will enable the early detection of potentially deadly complications.
Topics: Bioprosthesis; Emergencies; Heart Valve Prosthesis; Humans; Prosthesis Failure
PubMed: 8062789
DOI: No ID Found -
Current Problems in Cardiology Dec 2022Mycobacterium chimaera is an opportunistic and emerging pathogen, which has been recognized to cause prosthetic valve infective endocarditis and disseminated infection... (Review)
Review
Advanced Cardiovascular Imaging for the Diagnosis of Mycobacterium chimaera Prosthetic Valve Infective Endocarditis After Open-heart Surgery: A Contemporary Systematic Review.
Mycobacterium chimaera is an opportunistic and emerging pathogen, which has been recognized to cause prosthetic valve infective endocarditis and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnostic evaluation of suspected prosthetic valve infective endocarditis due to M chimaera is challenging and requires a very high index of suspicion. This systematic review aims to evaluate prosthetic valve infective endocarditis due to M chimaera. Based on the current literature review, transesophageal echocardiography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography are the most common imaging modalities used to establish the diagnosis. Based on 22 published cases, the reported cases of M chimaera endocarditis have occurred almost entirely in males. Within this cohort, the patients developed endocarditis on average 2.7 years after exposure to contaminated heater-cooler systems during cardiac surgery. M chimaera infection is associated with significant morbidity and mortality.
Topics: Male; Humans; Mycobacterium; Endocarditis; Cardiac Surgical Procedures; Heart Valve Prosthesis
PubMed: 36100093
DOI: 10.1016/j.cpcardiol.2022.101392 -
Cardiology Clinics Aug 1998Although most of the available prosthetic heart valves function remarkably well, the variety of available choices attests to the inability of any single one to fulfill... (Comparative Study)
Comparative Study Review
Although most of the available prosthetic heart valves function remarkably well, the variety of available choices attests to the inability of any single one to fulfill the requirements of the ideal valve substitute. The mechanical prostheses include the caged-ball, tilting-disc, and bileaflet valves. Tissue valves available in the United States are the Carpentier-Edwards and Hancock porcine heterograft valves and the Carpentier-Edwards pericardial valve. Review of several large comparative studies on valve performance reveals that the overall results with tissue and mechanical valves are about equal at the end of 10 years. The characteristics of each type of valve substitute dictate the selection of one prosthesis in preference to others for a particular patient. Mechanical prostheses are recommended for patients without contraindications for anticoagulants. Tissue valves are reserved for patients over 65 years of age or for patients in whom anticoagulation is contraindicated. Multiple other patient-related factors need to be considered in selecting the appropriate valve, including the psychosocial situation and patient preference.
Topics: Biocompatible Materials; Bioprosthesis; Decision Making; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Prosthesis Design
PubMed: 9742327
DOI: 10.1016/s0733-8651(05)70028-x -
The Journal of Thoracic and... Oct 2019Intraoperative surgical prosthetic heart valve (SHV) choice is a key determinant of successful surgery and positive postoperative outcomes. Currently, many controversies... (Review)
Review
Characteristics of surgical prosthetic heart valves and problems around labeling: A document from the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force.
Intraoperative surgical prosthetic heart valve (SHV) choice is a key determinant of successful surgery and positive postoperative outcomes. Currently, many controversies exist around the sizing and labeling of SHVs rendering the comparison of different valves difficult. To explore solutions, an expert Valve Labelling Task Force was jointly initiated by the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS). The EACTS-STS-AATS Valve Labelling Task Force, comprising cardiac surgeons, cardiologists, engineers, regulators and representatives from the International Organization for Standardization (ISO), and major valve manufacturers, held its first in-person meeting in February 2018 in Paris, France. This article was derived from the meeting's discussions. The Task Force identified the following areas for improvement and clarification: reporting of physical dimensions and characteristics of SHVs determining and labeling of SHV size, in vivo and in vitro testing, and reporting of SHV hemodynamic performance and thrombogenicity. Furthermore, a thorough understanding of the regulatory background and the role of the applicable ISO standards, together with close cooperation between all stakeholders (including regulatory and standard- setting bodies), is necessary to improve the current situation. Cardiac surgeons should be provided with appropriate information to allow for optimal SHV choice. This first article from the EACTS-STS-AATS Valve Labelling Task Force summarizes the background of SHV sizing and labeling and identifies the most important elements where further standardization is necessary.
Topics: Bioprosthesis; Cardiology; Clinical Decision-Making; Consensus; Consumer Product Safety; Equipment Failure Analysis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Product Labeling; Prosthesis Design; Prosthesis Failure; Societies, Medical
PubMed: 31084981
DOI: 10.1016/j.jtcvs.2019.04.001 -
European Journal of Cardio-thoracic... Jun 2019Intraoperative surgical prosthetic heart valve (SHV) choice is a key determinant of successful surgery and positive postoperative outcomes. Currently, many controversies... (Review)
Review
Characteristics of surgical prosthetic heart valves and problems around labelling: a document from the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force.
Intraoperative surgical prosthetic heart valve (SHV) choice is a key determinant of successful surgery and positive postoperative outcomes. Currently, many controversies exist around the sizing and labelling of SHVs rendering the comparison of different valves difficult. To explore solutions, an expert Valve Labelling Task Force was jointly initiated by the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS). The EACTS-STS-AATS Valve Labelling Task Force, comprising cardiac surgeons, cardiologists, engineers, regulators and representatives from the International Organization for Standardization (ISO) and major valve manufacturers, held its first in-person meeting in February 2018 in Paris, France. This article was derived from the meeting's discussions. The Task Force identified the following areas for improvement and clarification: reporting of physical dimensions and characteristics of SHVs determining and labelling of SHV size, in vivo and in vitro testing and reporting of SHV haemodynamic performance and thrombogenicity. Furthermore, a thorough understanding of the regulatory background and the role of the applicable ISO standards, together with close cooperation between all stakeholders (including regulatory and standard-setting bodies), is necessary to improve the current situation. Cardiac surgeons should be provided with appropriate information to allow for optimal SHV choice. This first article from the EACTS-STS-AATS Valve Labelling Task Force summarizes the background of SHV sizing and labelling and identifies the most important elements where further standardization is necessary.
Topics: Europe; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Product Labeling; Prosthesis Design; Societies, Medical; Thoracic Surgery; United States
PubMed: 31075173
DOI: 10.1093/ejcts/ezz034