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Journal of Thrombosis and Haemostasis :... Sep 2015To perform a systematic review and meta-analysis of studies evaluating anticoagulation during the early postoperative period following mechanical heart valve... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To perform a systematic review and meta-analysis of studies evaluating anticoagulation during the early postoperative period following mechanical heart valve implantation.
METHODS
Five literature databases were searched to assess the rates of bleeding and thromboembolic events among patients receiving oral anticoagulation (OAC), both with and without bridging anticoagulation therapy with unfractionated heparin (UFH) or subcutaneous low molecular weight heparin (LMWH). The studies' results were pooled via a mixed effects meta-analysis. Heterogeneity (I(2) ) and publication bias were both evaluated.
RESULTS
Twenty-three studies including 9534 patients were included. The bleeding rates were 1.8% (95% confidence interval CI 1.0-3.3) in the group receiving OAC, 2.2% (95% CI 0.9-5.3) in the OAC + UFH group, and 5.5% (95% CI 2.9-10.4) in the OAC + LMWH group (P = 0.042). The thromboembolic event rate was 2.1% (95% CI 1.5-2.9) in the group receiving OAC, as compared with 1.1% (95% CI 0.7-1.8) when the bridging therapy groups were combined as follows: OAC + UFH and OAC + LMWH (P = 0.035). Most of the analyses showed moderate heterogeneity and negative test results for publication bias.
CONCLUSIONS
Bridging therapy following cardiac valve surgery was associated with a lower thromboembolic event rate, although the difference was small, with considerable overlap of the CIs. Direct comparisons are missing. Bridging therapy with UFH appears to be safe; however, this observation has a risk of bias. Early bridging therapy with LMWH appears to be associated with consistently high bleeding rates across multiple analyses. On the basis of the quality of the included studies, more trials are necessary to establish the clinical relevance of bridging therapy and the safety of LMWH.
Topics: Administration, Oral; Anticoagulants; Case-Control Studies; Cohort Studies; Equipment Design; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Hospital Mortality; Humans; Postoperative Complications; Postoperative Period; Publication Bias; Thromboembolism; Thrombophilia; Treatment Outcome; Warfarin
PubMed: 26178802
DOI: 10.1111/jth.13047 -
JACC. Cardiovascular Interventions Feb 2015The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve... (Review)
Review
OBJECTIVES
The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR).
BACKGROUND
Very few data exist on PVE after TVR.
METHODS
Studies published between 2000 and 2013 regarding PVE in patients with transcatheter aortic valve replacement (TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified through a systematic electronic search.
RESULTS
A total of 28 publications describing 60 patients (32 TAVRs, 28 TPVRs) were identified. Most TAVR patients (66% male, 80 ± 7 years of age) had a very high-risk profile (mean logistic EuroSCORE: 30.4 ± 14.0%). In TPVR patients (90% male, 19 ± 6 years of age), PVE was more frequent in the stenotic conduit/valve (61%). The median time between TVR and infective endocarditis was 5 months (interquartile range: 2 to 9 months). Typical microorganisms were mostly found with a higher incidence of enterococci after TAVR (34.4%), and Staphylococcus aureus after TPVR (29.4%). As many as 60% of the TAVR-PVE patients were managed medically despite related complications such as local extension, embolism, and heart failure in more than 50% of patients. The valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively. In-hospital mortality for TAVR-PVE was 34.4%. Most TPVR-PVE patients (75%) were managed surgically, and in-hospital mortality was 7.1%.
CONCLUSIONS
Most cases of PVE post-TVR involved male patients, with a very high-risk profile (TAVR) or underlying stenotic conduit/valve (TPVR). Typical, but different, microorganisms of PVE were involved in one-half of the TAVR and TPVR cases. Most TPVR-PVE patients were managed surgically as opposed to TAVR patients, and the mortality rate was high, especially in the TAVR cohort.
Topics: Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Pulmonary Valve; Risk Factors; Transcatheter Aortic Valve Replacement
PubMed: 25700757
DOI: 10.1016/j.jcin.2014.09.013 -
Kardiochirurgia I Torakochirurgia... Mar 2021For patients with heart valve replacement, self-management can play an essential role in the management of their condition.
INTRODUCTION
For patients with heart valve replacement, self-management can play an essential role in the management of their condition.
AIM
This review aimed to identify the aspects of self-management and its clinical outcomes in patients with heart valve replacement.
MATERIAL AND METHODS
In this systematic review, the peer-reviewed research literature on self-management of patients with heart valve replacement was assessed. Since May 2020, the PubMed, Scopus, and web of science databases were searched regardless of time and language limitations. The eligibility of the articles was assessed by title or abstract according to the search strategy. Article selection was applied regarding to inclusion and exclusion criteria. Also, article screening was conducted by 2 independent authors.
RESULTS
Twenty-five studies were considered in this systematic review. For inclusion, the self-management of patients had to have prerequisites, appropriate training, and be applicable in the aspects of anticoagulation therapy self-management, international normalized ratio (INR) self-testing, low-dose INR self-management, and heart valve function self-monitoring. In this method, through proper management of INR levels and anticoagulation therapy, the complications rate could be reduced and the patients would be able to diagnose functional disorders in the early stages by monitoring the valve function. This procedure was able to prevent the progression of complications.
CONCLUSIONS
Self-management is an applicable protocol in the field of anticoagulation therapy, INR control, low-dose INR management, and the monitoring of cardiac valve function. This protocol could improve the quality of treatment for these patients through upgrading the care standards.
PubMed: 34552643
DOI: 10.5114/kitp.2021.105186 -
The European Journal of Health... Mar 2018To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality. (Review)
Review
OBJECTIVE
To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality.
METHODS
A systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist.
RESULTS
Fourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation (TAVI) was cost-effective compared to standard treatment (ST) in inoperable or high-risk operable patients (ICER range 18,421-120,779 €) and in all studies surgical aortic valve replacement (SAVR) was cost-effective compared to ST in operable patients (ICER range 14,108-40,944 €), but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients (ICER range: dominant to dominated by SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good.
CONCLUSION
This review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency (i.e. validity) of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.
Topics: Aortic Valve Stenosis; Cost-Benefit Analysis; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Models, Economic; Risk Assessment
PubMed: 28265822
DOI: 10.1007/s10198-017-0880-z -
Journal of Cardiothoracic Surgery Apr 2023New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation.
METHODS
A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival.
RESULTS
Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable.
CONCLUSION
To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes.
KEY QUESTION
What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement?
KEY FINDINGS
Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity.
KEY OUTCOMES
Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
Topics: Humans; Heart Valve Prosthesis Implantation; Follow-Up Studies; Heart Valve Prosthesis; Aortic Valve; Aortic Valve Stenosis
PubMed: 37041628
DOI: 10.1186/s13019-023-02273-7 -
Current Cardiology Reviews 2022Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily...
BACKGROUND
Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences.
OBJECTIVE
Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success.
METHODS
A comprehensive literature search was undertaken to formulate this narrative review.
RESULTS
This review highlights the complex nature of PVL and the promising contemporary treatments available.
CONCLUSION
Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
Topics: Humans; Aortic Valve; Aortic Valve Insufficiency; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35546743
DOI: 10.2174/1573403X18666220511113310 -
The American Journal of Cardiology Nov 2023This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.
Topics: Adult; Humans; Mitral Valve Insufficiency; Mitral Valve; Treatment Outcome; Cardiac Surgical Procedures; Heart Failure; Heart Valve Prosthesis Implantation
PubMed: 37741106
DOI: 10.1016/j.amjcard.2023.08.097 -
Frontiers in Cardiovascular Medicine 2021New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of...
New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.
PubMed: 34422930
DOI: 10.3389/fcvm.2021.702780 -
The Journal of Thoracic and... Jan 2016Despite an increasing interest in pediatric aortic valve repair, aortic valve replacement in children may be unavoidable. The evidence on outcome after pediatric aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Despite an increasing interest in pediatric aortic valve repair, aortic valve replacement in children may be unavoidable. The evidence on outcome after pediatric aortic valve replacement is limited and usually reported in small case series. This systematic review and meta-analysis aims to provide an overview of reported outcome of pediatric patients after aortic valve replacement.
METHODS
A systematic literature search for publications reporting outcome after pediatric aortic valve replacement published between January 1990 and May 2015 was conducted. Studies written in English with a study size of more than 30 patients were included.
RESULTS
Thirty-four publications reporting on 42 cohorts were included in this review: 26 concerning the Ross procedure (n = 2409), 13 concerning mechanical prosthesis aortic valve replacement (n = 696), and 3 concerning homograft aortic valve replacement (n = 224). There were no studies on bioprostheses that met our inclusion criteria. The pooled mean patient age was 9.4 years, 12.8 years, and 8.9 years for Ross, mechanical prosthesis, and homograft recipients, respectively. Pooled mean follow-up was 6.6 years. The Ross procedure was associated with lower early (4.20%; 95% confidence interval [CI], 3.37-5.22 vs 7.34%; 95% CI, 5.21-10.34 vs 12.82%; 95% CI, 8.91-18.46) and late mortality (0.64%/y; 95% CI, 0.49-0.84 vs 1.23%/y; 95% CI, 0.85-1.79 vs 1.59%/y; 95% CI, 1.03-2.46) compared with mechanical prosthesis aortic valve replacement and homograft aortic valve replacement, respectively. No significantly different aortic valve reoperation rates were observed between the Ross procedure and mechanical prosthesis aortic valve replacement (1.60%/y; 95% CI, 1.27-2.02 vs 1.07%/y; 95% CI, 0.68-1.68, respectively), whereas homograft aortic valve replacement was associated with significantly higher aortic valve reoperation rates (5.44%/y; 95% CI, 4.24-6.98). The Ross procedure-associated right ventricular outflow tract reoperation rate was 1.91% per year (95% CI, 1.50-2.44).
CONCLUSIONS
This systematic review illustrates that all currently available aortic valve substitutes are associated with suboptimal results in children, reflecting the urgent need for reliable and durable repair techniques and innovative replacement solutions for this challenging group of patients.
Topics: Adolescent; Age Factors; Allografts; Aortic Valve; Chi-Square Distribution; Child; Child, Preschool; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Infant; Postoperative Complications; Prosthesis Design; Reoperation; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26541831
DOI: 10.1016/j.jtcvs.2015.09.083 -
Journal of Thrombosis and Thrombolysis Apr 2023Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased... (Review)
Review
Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased inflammatory response in the setting of COVID-19 infection is associated with VTE and hypercoagulability. Venous and arterial thrombotic events in COVID-19 infection have been well documented; however, few cases have been reported involving cardiac valve prostheses. In this review, we present a total of eight cases involving COVID-19-related prosthetic valve thrombosis (PVT), as identified in a systematic review. These eight cases describe valve position (mitral versus aortic) and prosthesis type (bioprosthetic versus mechanical), and all cases demonstrate incidents of PVT associated with simultaneous or recent COVID-19 infection. None of these eight cases display obvious non-adherence to anticoagulation; five of the cases occurred greater than three years after the most recent valve replacement. Our review offers insights into PVT in COVID-19 infected patients including an indication for increased monitoring in the peri-infectious period. We explore valve thrombosis as a mechanism for prosthetic valve failure. We describe potential differences in antithrombotic strategies that may offer added antithrombotic protection during COVID-19 infection. With the growing population of valve replacement patients and recurring COVID-19 infection surges, it is imperative to explore relationships between COVID-19 and PVT.
Topics: Humans; Fibrinolytic Agents; Venous Thromboembolism; COVID-19; SARS-CoV-2; Heart Valve Diseases; Heart Valve Prosthesis; Thrombosis; Aortic Valve
PubMed: 36528721
DOI: 10.1007/s11239-022-02746-x