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JACC. Cardiovascular Imaging Oct 2011
Topics: Adult; Aged; Anticoagulants; Cardiac Valve Annuloplasty; Echocardiography, Transesophageal; Female; Heart Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Prosthesis Design; Thrombolytic Therapy; Thrombosis; Treatment Outcome
PubMed: 21999876
DOI: 10.1016/j.jcmg.2011.03.021 -
Journal of Internal Medicine Sep 2022Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
BACKGROUND
Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
OBJECTIVES
This study aimed to investigate the microbiology of PVE depending on the type of prosthetic valve and timing of diagnosis.
METHODS
A retrospective study based on the Swedish Registry on Infective Endocarditis focusing on PVE was conducted. The cohort was divided into mechanical and bioprosthetic valves; into endocarditis localization in the aortic, mitral, or tricuspid valve; and into early and late PVE. The microbiology in these groups was compared. Predictors of Staphylococcus aureus as the cause of PVE were examined by multivariable logistic regression.
RESULTS
A total of 780 episodes of PVE in 749 patients were compared regarding the distribution of causative microbiological agents. The most common agents included alpha-hemolytic streptococci (29%), S. aureus (22%), enterococci (14%), coagulase-negative staphylococci (CoNS) (12%), and Cutibacterium acnes (6%). S. aureus was more commonly found on mechanical valves compared to bioprosthetic ones (36% vs. 17%, p < 0.001) whereas alpha-hemolytic streptococci, enterococci, and CoNS were more common on bioprosthetic valves. There were no significant differences in the microbiology of PVE affecting mitral or aortic valves or in cases of early and late PVE. Predictors for S. aureus as the cause of PVE were end-stage renal disease, intravenous drug use, mechanical valve, and tricuspid localization of endocarditis.
CONCLUSIONS
The type of prosthetic heart valve is associated with the causative pathogen. Patients with mechanical valves are more likely to have PVE caused by S. aureus.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections; Registries; Retrospective Studies; Staphylococcus aureus
PubMed: 35373870
DOI: 10.1111/joim.13491 -
JAMA Network Open May 2023
Topics: Humans; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Cardiac Surgical Procedures; Age Factors; Heart Valves
PubMed: 37213105
DOI: 10.1001/jamanetworkopen.2023.14628 -
Cardiology Clinics May 1991Although most of the available prosthetic heart valves function remarkably well, the variety of available designs 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 designs 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 heterograph valves. 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 dictates 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 70 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: Bioprosthesis; Heart Valve Prosthesis; Humans
PubMed: 2054821
DOI: No ID Found -
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 -
International Journal of Cardiology Oct 2015To assess the effectiveness of different treatment strategies in patients with non-obstructive prosthetic valve thrombosis (NOPVT) during hospitalization and long-term...
AIMS
To assess the effectiveness of different treatment strategies in patients with non-obstructive prosthetic valve thrombosis (NOPVT) during hospitalization and long-term follow-up.
METHODS
NOPVT was diagnosed by transesophageal echocardiography. Resolution was defined as the disappearance or reduction of the thrombus under anticoagulation. All cases were first managed with optimization of anticoagulation. At discharge, patients received oral anticoagulation (OAC) alone or OAC and antiplatelet therapy (double treatment). Adverse events were defined as cardiovascular death, recurrence, thromboembolic events or major bleeding.
RESULTS
From 1997 to 2012, 47 patients (mean age: 65years; women: 60%) were diagnosed with NOPVT (mitral valve: 97%). Previous poor anticoagulation control was documented in 66% of patients. Twenty-one patients (45%) were treated with unfractionated heparin (UFH), especially those with thrombus size >10mm (19/21). Optimization of OAC was performed in the remaining patients. Treatment failed in 13 (27.6%) patients, mostly in those who received UFH (10/13), requiring surgery (53.8%) or fibrinolysis (30.7%). Forty-two patients survived and, at discharge, 44% of patients received OAC alone and 56% the double treatment. At follow-up (median 23months; range 0.03-116months), 59.5% of patients presented cardiovascular events, however no differences in outcome were observed with double treatment or OAC alone (p=0.385).
CONCLUSIONS
NOPVT is a high-risk complication, not only during hospitalization but also during follow-up. Optimization of anticoagulation is efficient in most patients except in thrombi ≥10mm treated with UFH. The double treatment does not prevent adverse events or complications during follow-up.
Topics: Aged; Anticoagulants; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Prospective Studies; Recurrence; Thromboembolism; Thrombosis
PubMed: 26113471
DOI: 10.1016/j.ijcard.2015.06.021 -
Lancet (London, England) Jul 1988
Topics: Female; Graft Occlusion, Vascular; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve
PubMed: 2899251
DOI: 10.1016/s0140-6736(88)92555-x -
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 -
Heart, Lung & Circulation Mar 2018
Topics: Aged; Endocarditis, Bacterial; Germany; Heart Valve Prosthesis; Humans; Incidence; Prosthesis-Related Infections
PubMed: 29102435
DOI: 10.1016/j.hlc.2017.09.009 -
Cardiology in the Young Aug 2021A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed...
A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.
Topics: Child; Female; Fibrinolytic Agents; Heart Valve Prosthesis; Humans; Mitral Valve; Tenecteplase; Thrombolytic Therapy; Thrombosis
PubMed: 33658096
DOI: 10.1017/S1047951121000603