Abstract
BackgroundMechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes.ResultsThe median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05).ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities.ConclusionThe simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.
Highlights
Mechanical prosthetic heart valves are known for their durability; a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication
In our experience, mitral valve repair is not always feasible in the young rheumatic population and valve replacement with a mechanical valve is preferred over the use of a bioprosthesis, which is likely to degenerate over time and require reintervention [1]
We suggested that every prosthesis is doomed to become malfunctioning 1 day or another and the period that elapsed between the date of implantation of the prosthesis and the appearance of the signs and or symptoms suggesting prosthetic heart valve thrombosis (PVT) was recorded in months and was called the latent period of malfunction (LPM)
Summary
Mechanical prosthetic heart valves are known for their durability; a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Mechanical valves have long term durability, yet the incidence of malfunction is not negligible (0.1-6%) and mechanical prosthetic valve thrombosis (PVT) is one of those serious complications, where patients often deteriorate rapidly, compromising management outcomes. The aim of this study was to express the rate by which those patients deteriorate clinically by a simple numerical index and to test its value in monitoring hospital progression and predicting outcomes of surgery.
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