Mechanical Valve Research Articles

Anticoagulation with warfarin for paediatric cardiac indications: a retrospective study.

Warfarin is used as anticoagulation for children for a wide range of cardiac indications but carries the disadvantage of requiring international normalised ratio monitoring and dose adjustment. Management of warfarin therapy is challenging due to its narrow therapeutic window and is further complicated in children by dietary changes, frequent illnesses, and developing systems of metabolism and haemostasis.A retrospective review was performed of patients' medical records to assess the indication for warfarin use, percentage of international normalised ratio values in target range (%ITR), and frequency of phlebotomy.Twenty-six patients were identified. The most common indication for warfarin use was in patients post-total cavo-pulmonary connection (n = 19, 73%). We demonstrated a variability in duration of warfarin therapy following total cavo-pulmonary connection (median of 11.1 months). Nineteen (73%) patients had used the CoaguChek machine for home measurement of international normalised ratio. The median frequency of phlebotomy for all indications was once every 10 days, and the median %ITR was 55.4 % (29.7-86.4%). Of note, the percentage under target range in the patients with mechanical mitral (n = 2) and aortic valves (n = 1) was found to be 23% and 33%, respectively.These data demonstrate a high frequency of international normalised ratio values outside of the target range as seen in previous studies of warfarin in children. This necessitates frequent phlebotomy and dose changes, which can have a significant effect on the quality of life of these patients and their families highlighting the need to focus on quality improvement in the area of anticoagulation in paediatric cardiac patients.

Management of multiple valve replacement operations for a young patient with hypereosinophilic syndrome and valvular heart disease: a case report.

Hypereosinophilic syndrome (HES) is characterized by the overproduction of eosinophils and manifests as valvular disease and thrombogenesis. Herein, we report our experience with a patient with HES requiring multiple reoperations for prosthetic heart valve replacement via median sternotomy. The patient was a 54-year-old man who had undergone four valve replacement operations via median sternotomy (three mitral valve replacements and one double valve replacement) because of valvular diseases complicated by HES since he was 26years old. All the artificial valves were bioprosthetic to prevent thrombotic events. At presentation, he had developed structural deterioration of the artificial aortic valve with severe stenosis. His prosthetic mitral valve did not fulfil the criteria for intervention, as it exhibited only mild regurgitation and no stenosis. The explanted mitral prosthetic valve at the previous (fourth) surgery had exhibited eosinophilic infiltration, resulting in the introduction of cyclosporin for poorly controlled HES. We conducted re-aortic valve replacement via a fifth median sternotomy using a bioprosthetic valve, and no eosinophilic infiltration was observed in the explanted valve. The patient was discharged on postoperative day 15 without complications. Controlling eosinophil count during the pre- and postoperative course is vital in treating patients with HES after valve replacement surgery. A holistic management and therapeutic strategy, including prosthetic valve selection and medication for HES is required to improve outcomes of patients with HES and heart valve disease.

Direct Oral Anticoagulants Versus Warfarin in Patients With Isolated Heparin-Induced Thrombocytopenia or Heparin-Induced Thrombocytopenia With Thrombosis.

No existing studies compare oral anticoagulants to treat heparin-induced thrombocytopenia with or without thrombosis (HIT/HITT). This retrospective study evaluated thrombotic and bleeding outcomes in adults treated for HIT/HITT with a direct oral anticoagulant (DOAC) or warfarin between 2012 and 2023 within the Ochsner Health System. Patients with mechanical heart valves, valvular atrial fibrillation, antiphospholipid syndrome, active malignancy, or venous thromboembolism (VTE) within the previous 6 months were excluded. The primary outcome was a composite of new or progressive VTE or arterial thromboembolism. Secondary outcomes included major and clinically relevant non-major bleeding, duration of hospitalization, time to platelet recovery, and incidence of skin necrosis, gangrene, and amputation. Forty-nine patients receiving a DOAC and 30 patients receiving warfarin were included. Baseline characteristics were similar between cohorts. There were non-statistically significant increased rates of both the primary outcome (8.9% vs. 4.3%, p = 0.65) and the composite bleeding outcome (32.7% vs. 23.3%, p = 0.37) in the DOAC cohort. Larger, prospective studies are needed to confirm these findings.

The Problem of the Sexy Cyborg: The Ethics of Cyborg Imagery

In this article, I discuss two popular tropes about the cyborg in speculative fiction visual media: apotheosis — the pinnacle of human form and function; and grotesquerie — the violation of that perfection through fascinating horror. I look at these tropes in service of discussing the effects of such images and cultural understandings on actual cyborgs. The everyday or common cyborgs that are disabled people; the ones with prosthetics, who use wheelchairs, hearing aids, beta blockers, and Ritalin, who have artificial valves, knees, and pacemakers. I argue that the imagery of perfection and horror that surround cyborgs in media reinforce problematic tropes about disabled people, specifically the tropes of the super crip, pity, and bitter cripple narratives, and the ugly is evil trope where physical disfigurements and disabilities are often shorthand for moral failing. I connect these tropes to longstanding beliefs that were foundational to the eugenics movement of the 19th and 20th centuries, and that still cause resistance to robust social services for disabled people.

Abstract 4138345: Incidence and Predictors of Infective Endocarditis in Bacteremic Patients

Background: Infective endocarditis (IE) is a serious disease, with a high mortality rate.There has been a shift in the composition of organisms causing infective endocarditis. We aimed to provide a contemporary incidence of IE among bacteremic patients stratified by bacterial pathogens. We also sought to evaluate the predictors of IE in bacteremic patients. Methods: We included patients at a large quaternary centre in Canada. All bacteremias during the period from 2014 to 2016 were identified and data was collected on the following variables – patient demographics, organism, comorbidities, pre-disposing factors, clinical findings, pertinent biochemistry, performance of echocardiography, and diagnosis of IE. Diagnosis of IE was made using the modified Duke’s criteria. Logistic regression was used to identify predictors of IE. Results: There were 1,708 patients with bacteremia included in this analysis. The mean age was 64.5±17.0 years old; 39.7% were females and 77.4% were community acquired bacteremia. In addition, 47.0% had hypertension, 29.9% had diabetes mellitus, 17.5% had chronic kidney disease and 25.2% were immunosuppressed. There were 102 (6.0%) patients with confirmed infective endocarditis (IE). The proportion of bacteremic patients who developed IE was 13.2% in 281 patients with methicillin-sensitive Staphylococcus aureus, 5.4% in 56 patients with methicillin-resistant S. aureus, 2.4% in 292 patients with S. epidermidis, 9.9% in 121 patients with Streptococcus viridans group, 16.5% in 91 patients with Enterococcus, 1.3% in 303 patients with Escherichia coli, 38.5% in 13 in patients with Streptococcus bovis, and 9.5% in 21 patients with Propionibacterium acnes. Predictors of IE were intravenous drug use (odds ratio [OR]=8.64, 95% confidence interval [CI] 3.50- 21.3; p<0.0001), prosthetic heart valve (OR= 2.10, 95% CI 1.01- 4.39; p=0.049), structural heart disease (OR= 12.2, 95% CI 3.35- 44.67; p= 0.0002) and community acquired bacteremia (OR= 2.06, 95% CI 1.11- 3.82; p=0.02). CONCLUSIONS: Methicillin-sensitive Staphylococcus aureus is the commonest cause overall of IE followed by viridans group streptococcus. Streptococcus bovis and Enterococcus bacteremia have the highest incidence of IE. Knowledge of the incidence rates of IE among various pathogens may guide diagnostic testing such as pursuing more advanced imaging procedures for patients with increased risk of IE.

Prosthetic Valve Fate in Patients With Continuous-Flow Left Ventricular Assist Devices.

Prosthetic valve-related morbidity and mortality in patients with left ventricular assist devices (LVADs) remain unclear. We retrospectively reviewed patients who received a HeartMate II or 3 LVAD at our center between April 2004 and December 2022. Patients with a valve prosthesis in any position were included. Of the 726 LVAD recipients, 74 (10.2%) underwent valve replacement before (n = 37, 50.0%), concomitantly with (n = 32, 43.2%), or after (n = 6, 8.1%) LVAD insertion. Prosthetic valves were implanted in the aortic (n = 32), mitral (n = 23), and tricuspid (n = 26) positions. Mechanical valves were present in eight (three aortic, five mitral) patients. At a median follow-up of 1.97 years post-VAD (interquartile range [IQR]: 0.56-4.58 years), there was one valve-related death due to severe aortic bioprosthetic insufficiency. Five of 28 (17.9%) patients with an aortic bioprosthesis had evidence of dysfunction on follow-up echocardiography. Median time to first sign of aortic bioprosthetic valve dysfunction was 1 (IQR: 0.6-5.1) year from time of LVAD with the prosthesis in place and 10.8 (IQR: 9.5-12.6) years from date of initial valve insertion. Prosthetic valve-related mortality or reinterventions are uncommon in patients with LVADs; however, bioprosthetic aortic valve dysfunction can develop less than 1 year after LVAD implantation.

ENDOCARDITE BACTERIANA E PROFILAXIA ANTIBIÓTICA NA ODONTOLOGIA: MANEJO E PREVENÇÃO EM PACIENTES DE RISCO

This study addresses bacterial endocarditis, a severe inflammatory condition of the endocardium caused by the colonization of pathogenic bacteria or fungi. The objective was to analyze and synthesize evidence regarding risk factors, pathogenic mechanisms, diagnostic methods, prevention strategies, and therapeutic approaches for this disease, with an emphasis on the relationship between oral infections and bacterial endocarditis. A literature review was conducted, selecting articles from the PubMed, Medline, and Google Scholar databases published between 2011 and 2024, using specific keywords: "Bacterial Endocarditis," "Oral Infections," "Antibiotic Prophylaxis," "Dental Biofilm," and applying rigorous inclusion and exclusion criteria to ensure the relevance and quality of the studies. The literature unanimously indicates that antibiotic prophylaxis is the best way to prevent the development of bacterial endocarditis (BE), particularly in patients with risk factors, such as those with congenital heart diseases or valve prostheses. Administering antibiotics before procedures that may cause bacteremia is essential to reduce the risk of infection. Effective prevention involves not only antibiotic prophylaxis but also continuous education for patients and healthcare professionals about the importance of maintaining oral health to prevent systemic complications. The adoption of preventive measures can significantly reduce the incidence of BE, especially in individuals with preexisting heart conditions. In this sense, dentistry plays a vital role, as dental procedures can cause temporary bacteremia, and collaboration between healthcare professionals and dentists is crucial to ensure the protection of these patients.

Abstract 4129273: Severe Mitral Regurgitation from Impella-associated Mitral Chordae Rupture with Successful Transcatheter Edge-to-edge Repair

Background: Limited data exists describing Impella-related mechanical mitral valve complications. Diagnosis and management can be challenging due to potential underestimation of mitral regurgitation severity from Impella and acute clinical deterioration upon removal. We present a case of successful mitral transcatheter edge-to-edge repair (TEER) for acute severe MR secondary to Impella-related mitral chordae rupture resulting in acute pulmonary edema post-Impella removal. Case Summary: A 37-year-old male smoker presented with chest pain complicated by cardiac arrest due to ventricular fibrillation. Spontaneous circulation could not be restored, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Coronary angiography revealed total occlusion of the proximal left anterior descending artery, which was successfully stented. Transfemoral Impella CP was placed for left ventricular venting under fluoroscopy (Panel A) with TTE showing no complications. In the intensive care unit, the Impella was advanced under TTE guidance; its tip was found to be positioned deep at the base of the posteromedial pupillary muscle without suction alarms or ventricular arrhythmias on the following day (Panel B). Several days later, TTE revealed new eccentric MR with hyperdynamic left ventricular motion (Panel C). The patient remained hemodynamically stable after VA-ECMO decannulation with Impella at P4. Following Impella removal, he developed repeated flash pulmonary edema despite aggressive fluid removal attributed to acute severe MR secondary to a flail P3 leaflet with ruptured chordae tendineae confirmed by transesophageal echocardiography (Panel D). Given the patient's poor surgical candidacy with a STS score of 13.2%, the team proceeded with mitral TEER, successfully reducing MR severity from severe to mild with a single NT Mitraclip ® across the medial commissure (Panel E). His post-operative cardiac course was uneventful without recurrence of pulmonary edema. Discussion: Irreversible mechanical damage to the mitral valve apparatus caused by Impella placement and repositioning is a rare, potentially fatal complication requiring emergent intervention. Mitral TEER can be a viable salvage option for poor surgical candidates.

Abstract 4124430: Calcinosis Cutis and Heart Failure---A Rare Manifestation Which Should Never Be Ignored!

Introduction: Heart failure can be a manifestation of underlying immune mediated myopathies like dermatomyositis/polymyositis which can present in broad range of clinical manifestations and sometimes dermatologic lesions can be the only manifestation of these underlying pathologies without typically involving the muscle weakness. Calcinosis cutis is the deposition of calcium salts in the skin and subcutaneous tissue. There are five subtypes of calcinosis cutis, dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Case summary: 70-year-old female was evaluated for bilateral lower extremity swelling. Past medical history was significant for Graves’ disease, atrial fibrillation, mechanical aortic valve on warfarin, hypertension, hyperlipidemia, ascending aortic aneurysm. Work up showed BNP of 4700 pg/ml with normal cardiac enzymes. Transthoracic echocardiogram revealed newly reduced ejection fraction of 25—30% with severely dilated left ventricle. Patient refused cardiac catheterization. Nuclear stress test showed no evidence of ischemia. Patient was started on guideline directed medical therapy and biventricular Implantable cardioverter defibrillator device was placed as per cardiology recommendation. Six months later patient developed multiple calcinosis cutis lesions on abdominal wall requiring surgical excisions. Endocrine work up including PTH, serum Ca level was normal, however creatin kinase level was high normal (150 U/L). Serum aldolase was ordered which was found to be elevated(25U/L). Muscle biopsy was performed as per recommendations of rheumatology which was diagnostic of dermatomyositis. Patient was started on high dose steroids and methotrexate and eventually IV immunoglobulins as per rheumatology recommendation. Follow up echocardiogram revealed improved ejection fraction to 40--45% with resolution of any further lesion of calcinosis cutis afterwards. Conclusion: Cardiac involvement such as congestive heart failure can be a part of presentation of underlying untreated myopathies. Calcinosis cutis can be the only clinical manifestation of dermatomyositis affecting heart. Etiology of calcinosis cutis in patients with heart failure should be worked up properly. Dystrophic calcinosis cutis is the subtype associated with underlying autoimmune connective tissue diseases.

Abstract 4148073: Expect the Unexpected: Type A Aortic Dissection in Pregnant Patient with Marfan Syndrome

Case Description: A 26 yo woman with Marfan Syndrome (MFS, FBN1 ), ectopia lentis, aortic dilation and no family history of MFS or aortic dissection was evaluated for preconception counseling. She was asymptomatic, and the size of her aortic root (~4cm) and ascending aorta (~3.5cm) had been stable for over 5 years. She was counseled that risk of cardiac events during her pregnancy is high, but lower compared to those with aortic sizes >4.5cm. Once pregnant, she was followed closely with imaging every trimester (MRA at 25 weeks gestation showed stable aortic sizes). Cardio-obstetric recommendations included: CARPREG II score: 2, mWHO class: III, consideration of assisted second stage due to aortic root dilation. She was counseled on symptoms of aortic dissection and to seek emergency care should those symptoms arise. At 27 weeks gestation, she presented to the ED with intense chest and neck pain, shortness of breath, and headache. Emergent CT showed aortic root (4.1cm) and proximal ascending aortic dissection with propagation into the left main coronary artery (Figure 1). She underwent emergent C-section followed by aortic root and ascending aorta replacement and mechanical aortic valve replacement due to severe regurgitation. She was discharged in stable condition 8 days after an uncomplicated post-operative recovery. Her baby is recovering in the NICU. Discussion: While risk of aortic dissection in women with MFS is higher during pregnancy, recent studies suggest relative safety with aortic root diameters up to 4.5cm. Our case highlights that even at “lower risk” aortic sizes, aortic dissection remains an important risk for such women. Educating patients and providers about the acute symptoms of aortic dissection and forming an action plan for timely intervention can be lifesaving. Furthermore, some genetic mutations (e.g. TGBR1/2 or SMAD3 ) and sequence variants within the FBN1 gene may pose a higher risk of aortic dissection at smaller aortic diameters. Our patient’s pathogenic FBN1 mutation (-c.2114-5T>G, previously classified as a VUS) highlights the importance of genetic testing: prophylactic surgery at sizes <4.5cm may be considered with high-risk genetic variants or a family history of aortic dissection.

Abstract 4119874: Cost Effectiveness Analysis of Surgical Strategies Versus Medical Management for Rheumatic Heart Disease in Rwanda

Background: One third of the Rheumatic Heart Disease (RHD) burden is in sub-Saharan Africa. Without valve surgery, 17% of patients die. However, surgery is often deemed too expensive in this region despite the lack of cost-effectiveness analyses to support this assumption. Aim: Assess the cost-effectiveness of surgical strategies for RHD performed in Rwanda. Methods: We built a Markov model to simulate the progression of patients through different health states. We compared mechanical valve replacement, bioprosthetic valve replacement, and valve repair to medical management for patients with severe RHD. Probabilities of transitioning into different health states were derived from regional published studies. Micro-costing data was obtained from the cardiac surgery program to calculate total costs for each health state. Health effects were measured in quality-adjusted life years (QALYs) from the 2019 Global Burden of Disease Study. Sensitivity analysis was performed to account for model uncertainty. We used a willingness-to-pay threshold of three times the GDP per capita of Rwanda (USD$769). Results: All surgical strategies extended life expectancy compared to medical management, which only offered 5.05 QALYs. Mechanical valve replacement surgery was cost-effective with 11.31 QALYs for a lifetime cost of USD$10,721. The incremental cost effectiveness ratio compared to medical management was USD$1,596/QALY, which is below the willingness to pay threshold. Decreasing the initial cost of surgery and probability of long term stroke increased cost-effectiveness. Although bioprosthetic valve replacement and repair provided 6.43 and 5.70 additional QALYs compared to medical management, they had higher lifetime costs than mechanical valve replacement ($19,789.21, $22,477.27). As a result, they were not cost-effective. In the sensitivity analysis, they became cost effective if valve degeneration rates were 11% in 2 years from a baseline of 26% for repair, and 8% in 2 years from baseline of 14% for bioprosthetic valves. Conclusion: This study challenges the prevailing assumption that surgery is not cost-effective in Sub-Saharan Africa. Mechanical valve replacement surgery was most cost-effective. Watchful waiting with medical management is inexpensive but carries an average life expectancy of 5 years. Identifying cost-saving opportunities for mechanical valve replacement surgery and enhancing anticoagulation monitoring can make it even more economically favorable.

Cerebrovascular events after perioperative paroxysmal atrial fibrillation in patients undergoing aortic valve replacement.

Postoperative atrial fibrillation (POAF) is common after aortic valve replacement (AVR). However, the long-term risk of cerebrovascular ischemic events (CVA) associated with POAF in this scenario is not known. The study objective was to look at the long-term risk of stroke in patients undergoing AVR with POAF compared to those with no POAF, particularly in patients having a bioprosthetic valve and not discharged on anticoagulation. We also looked at the risk of peri-operative stroke and long-term mortality. A retrospective study of 831 patients undergoing AVR were followed up for a median of 6.5 years. The primary outcome was the occurrence of CVA after discharge, comparing those with to those without POAF, after excluding patients with a past history of atrial fibrillation (AF). They were divided into two cohorts, those having bioprosthetic valves (without oral anticoagulation), and those with a mechanical valve (with oral anticoagulation). Other outcomes studied were the incidence of early perioperative CVA comparing patients with a history of AF to those with no history, and long-term mortality in the different cohorts. There was no increased risk of long-term stroke in patients with POAF when compared to those without POAF, neither in bioprosthetic valves (adjusted HR 1.14; CI 95% 0.46-2.83, P=0.78)-nor in mechanical valves (adjusted HR 1.41; CI 95% 0.55-3.65, P=0.48). Patients with a history of AF had an increased risk of perioperative stroke (OR 1.5; CI 95% 1.3-13.8, P=0.01). Patients undergoing bioprosthetic AVR who develop POAF are not at an increased risk of stroke despite not being on any oral anticoagulation.

Haemorrhagic and thromboembolic outcomes in pregnant patients with mechanical heart valves who undergo interruption of anticoagulation for birth - A case series.

Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation. Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications. Design: case series, single centre. Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022. all pregnant women with mechanical heart valves (any type) who birthed. intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death. There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded. Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.

Pregnant Woman in Outcomes with Prosthetic Heart Valves

We here sought to assess thrombotic and hemorrhagic complications and associated risk factors during pregnancy, delivery, and postpartum in women with prosthetic heart valves (PHV). Methods: The retrospective cohort study covered January 2011 to December 2022. The objective of the study was to assess the risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery, and the postpartum period in women with PHV based on the experience of one perinatal center. We included 88 pregnancies with 77 prosthetic heart valves (PHV), which were divided into two groups, mechanical valve prostheses (MVP) (n = 64) and biological valve prosthesis (BVP) (n = 24). In the study we analyzed pregnancy outcomes, as well as thrombotic and hemorrhagic complication frequencies. Results: Of 88 pregnancies, 79 resulted in live births. In the MVP group, there were six miscarriages (9.4%) and two medical abortions (3.1%), including one due to Warfarin’s teratogenic effects. No miscarriages were reported in the BVP group, but one fetal mortality case (4.2%) occurred. During pregnancy, 11 MVP cases (17.2%) experienced thrombotic complications. In the BVP group, one patient (4.2%) had transient ischemic attack (TIA). Two MVP cases required surgical valve repair during pregnancy, and one in the post-delivery stage was caused by thrombotic complications. Postpartum, two MVP cases had strokes, and in one MVP patient, pulmonary embolism was registered, while no thrombotic complications occurred in the BVP group. Hemorrhagic complications affected 15 MVP cases (17.9%) in the postpartum period. There were no registered cases of maternal mortality. Conclusions: The effective control of anti-factor Xa activity reduced thrombotic events. However, the persistently high incidence of postpartum hemorrhagic complications suggests a need to reassess anticoagulant therapy regimens, lower target levels of anti-Xa, and reduce INR levels for discontinuing heparin bridge therapy. Despite the heightened mortality risk in MVP patients, our study cohort did not have any mortality cases, which contrasts with findings from other registries.

Stanford A aortic dissection 40 years after aortic valve replacement with a Starr–Edwards caged-ball prosthesis: a case report

Abstract Stanford A aortic dissection is one of the most devastating acute medical conditions due to its high morbidity and mortality. We describe a 77-year-old male patient with a medical history of surgical aortic valve replacement with a still functioning Starr–Edwards caged-ball valve 40 years prior. The patient was promptly diagnosed with an ascending aortic aneurysm and dissection, and an emergency Bentall procedure in deep hypothermic circulatory arrest was performed. This is, to the best of our knowledge, the first Stanford A dissection case described in the literature in a patient with Starr–Edwards valve, and the longest still functioning caged-ball valve to have been replaced with the Bentall procedure. We also discuss the caged-ball valve’s unfavorable hemodynamics as a potential predisposing factor of the dissection, as well as the patient’s supposed initial bicuspid aortic valve disease which could also predispose to aortic aneurysm formation and dissection.

Is there an indication for endocarditis prophylaxis in patients with cardiac devices?

Cardiac implantable electronic devices (CIED) are essential in treating cardiovascular disease, but their infections are serious complications. The number of patients with CIEDs is increasing, as are CIED infection rates and related endocarditis. These infections arise either from contamination during implantation or from secondary infections. Current guidelines do not support prophylactic antibiotics for CIED patients before dental or other invasive procedures, unless the patient has other risk factors (E.g. an artificial heart valve). Patients with fever or signs of a pocket infection should be treated in centers equipped for laser extraction.

FSI Modeling and Simulation of Blood Viscosity Impacts on Cavitation in Mechanical Heart Valves

FSI Modeling and Simulation of Blood Viscosity Impacts on Cavitation in Mechanical Heart Valves

Transcatheter Aortic Valve in Failing Mechanical Aortic Valve.

Transcatheter Aortic Valve in Failing Mechanical Aortic Valve.

Successful ablation of cavotricuspid isthmus dependent flutter through a mechanical tricuspid valve

Successful ablation of cavotricuspid isthmus dependent flutter through a mechanical tricuspid valve

Atopic dermatitis increases the risk of infective endocarditis in prosthetic heart valve patients – A retrospective study

Atopic dermatitis increases the risk of infective endocarditis in prosthetic heart valve patients – A retrospective study