Valve-related complications after mechanical heart valve implantation.

Yoshio Misawa

doi:10.1007/s00595-014-1104-0

Abstract

The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7–3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4–1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.

Highlights

In 2011, 19,164 patients underwent heart valve surgery in Japan, and the postoperative early death rate was 3.4 % [1]
We choose a mechanical valve for young adults and patients with endstage renal disease because of the more rapid onset of structural dysfunction of tissue valves [3]
In 1996, Lytle et al [21] showed that 13 % of 146 patients had in-hospital deaths, and in 2014, Grubitzsch et al [22] showed that the surgical mortality was 12.8 % among 149 consecutive patients with prosthetic valve endocarditis

Summary

Introduction

In 2011, 19,164 patients underwent heart valve surgery in Japan, and the postoperative early death rate was 3.4 % [1]. The number of heart valve surgeries is increasing, and the early mortality rate has remained stable for more than 10 years [2]. We choose a mechanical valve for young adults and patients with endstage renal disease because of the more rapid onset of structural dysfunction of tissue valves [3]. We review and discuss mechanical prosthetic valve-related complications. Our review of studies published after 2000 revealed a rate of valve-related complications of 0.7–3.5 % per patient-year [2, 8,9,10,11,12,13,14].

Thromboembolism and bleeding complications

Structural dysfunction

Findings

Conclusions