Abstract
Background: Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Our objectives were to determine the clinical characteristics of BPVT, and formulate a diagnostic model for BPVT. Methods: Patients requiring redo surgery after initial bioprosthetic valve (BPV) implantation were identified from the Mayo Clinic pathology database. Cases of BPVT were matched 2:1 with degenerated, non-thrombosed BPV. Multivariate linear logistic regression and receiver operating characteristic were used to formulate a diagnostic model for BPVT. Results: There were 46 BPVT cases identified between 1997-2013 (age=63 ±15, male=68%; aortic=29, mitral=9, tricuspid=7, pulmonary=1) and 92 controls matched by age, gender and prosthesis position. BPVT was present in 11.6% of 397 explants, and led to surgery significantly earlier than degeneration (median of 24 vs108 months, respectively, p<0.001). Thirty (65%) of all BPVT occurred beyond 12 months post implantation. Predictors of BPVT were 50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR] 12.7), paroxysmal atrial fibrillation (OR 5.19), subtherapeutic INR (OR 7.37), increased cusp thickness (OR 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value, AUC=0.91, P<0.0001. Conclusion: BPVT requiring reoperation occur in over 10% of patients receiving BPV and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT. It is crucial to consider the diagnosis of BPVT prior to referring for reoperation since therapy with VKA may reverse the BPV dysfunction and prevent reoperation. Figure Legend: (A) Incidence of BPVT thrombosis (B) Freedom from BPV dysfunction (C) ROC curve for prediction of BPVT
Published Version
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