Incidence Of Valve Thrombosis Research Articles

Incidence and outcomes of prosthetic valve thrombosis during peripheral extracorporeal membrane oxygenation.

In the context of postcardiotomy cardiogenic shock (PCCS) following valve replacement surgery, it may be necessary to implant a peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). This procedure, however, carries a risk of prosthetic valve thrombosis. The aim of this retrospective study was to describe the incidence and outcomes of prosthetic valve thrombosis after VA-ECMO support for PCCS and to report the associated risk factors. All consecutive adult patients who received pVA-ECMO for PCCS following a valve replacement procedure between January 2015 and October 2019 in our institution were included in this retrospective study. Outcome variables were prosthetic valve thrombosis, 30-day and hospital survival, pVA-ECMO-associated adverse events and surgery-related adverse events. During the 4-year study period, 549 patients received pVA-ECMO for PCCS. Among them, 152 had undergone a valve replacement procedure and 9 of these developed prosthetic valve thrombosis. The incidence of valve thrombosis at 30 days was 7.5 ± 2%. The cumulative incidence of prosthetic valve thrombosis was significantly lower with pVA-ECMO + intra-aortic balloon pump versus VA-ECMO alone (1.4 ± 1.4% vs 13.7 ± 4.7%, P = 0.021, respectively). Intra-aortic balloon pump use associated with pVA-ECMO (versus pVA-ECMO alone) was an independent protective factor against hospital death [odds ratio = 0.180 (0.068-0.478), P = 0.001]. After PCCS following valve replacement surgery, peripheral femoro-femoral VA-ECMO is associated with a low risk of acute valve thrombosis especially when associated with an intra-aortic balloon pump.

Rapid-Deployment Valves versus Conventional Valves in Aortic Valve Replacement in Intermediate-Risk Patients

Background: Aortic valve replacement (AVR) in intermediate-risk (IR) patients is particularly challenging when determining the type of prosthesis to use. Rapid-deployment valves (RD-V) are emerging as a potential alternative in this patient population. Objectives: To compare early mortality, postoperative complications, and transvalvular hemodynamic parameters between AVR with conventional valves and RD-V in IR patients. Methods: We conducted a retrospective observational study of consecutive IR patients (STS-Prom score 4-8) undergoing AVR with conventional prostheses and RD-V between 2007 and 2023. Results: A total of 205 patients were included (140 AVR vs. 65 RD-V). Surgical risk was similar between both groups (STS-Prom 5.07 % vs. 5.7 % respectively, p = 0.211). The minimally invasive approach was more common in the RD-V group (32.3% vs. 0.7%, p < 0.001). The cardiopulmonary bypass time and aortic cross-clamp time was significantly shorter in the RD-V group (134.5 vs. 100 min and 104 vs. 73 min, respectively, p < 0.001). There was a trend to lower incidence of pacemaker implantation in the conventional valve group (4.3% vs. 10.8%, p = 0.075). There were no significant differences in postoperative complications, and a strong trend to lower 30-dat mortality with RD-V (0% vs. 5.7% for conventional valves, p = 0.057). The mean postoperative gradient across the prosthesis was significantly lower in the RD-V group (7.90 ± 3.3 mm Hg vs. 12.74 ± 6.07 mm Hg, p < 0.001). There were no differences in the incidence of valve thrombosis or prosthetic endocarditis. Conclusions: Rapid deployment valves demonstrated trend to lower mortality, shorter cardiopulmonary bypass time and aortic cross-clamp time, improved hemodynamic profile, and were easier to implant via a minimally invasive approach.

INCIDENCE OF VALVE LEAFLET THROMBOSIS IN TRANSCATHETER AND SURGICAL BIOPROSTHETIC AORTIC VALVES BY 4D CT IMAGING

Background: The incidence of valve thrombosis after transcatheter aortic valve replacement (TAVR) and surgical AVR (SAVR) when referred for clinical and echocardiographic indications, as well as response to anticoagulation is unknown. Methods: Between 11/2015 and 10/2016, all patients with clinical

EComment. The current bioprosthesis of choice for aortic valve replacements

I read with great interest the paper by Yap et al. regarding the best valve substitute for aortic valve replacement [1]. In their results, they included six randomized controlled trials and nine cohort studies yielding a total of 9880 patients from 1974 to 2006. However, we found two additional relevant articles investigating the long-term durability of pericardial and porcine valves. Brown et al. from the Mayo clinic recently published an interesting article assessing the incidence of early thrombosis in patients with biological valves [2]. The paper was in favour of bovine valves because all patients with early valve thrombosis requiring reoperation were implanted with porcine valves. The calculated incidence of valve thrombosis was 1.26% for the Biocor valve, 0.84% for the Hancock valve and 0.37% for the Mosaic valve. There were no patients with valve thrombosis in the pericardial valve cohort. One possible explanation of this discrepancy is related to the design of the porcine valve stent, which promotes blood stasis between the rail of the stent and the belly of the leaflet. Based on their findings, they recommended the implantation of a mechanical or a pericardial valve, in case of early thrombosis of a porcine valve. Grunkemeier et al. reviewed the long-term durability of the Carpentier-Edwards pericardial and bovine aortic valves in 2955 patients [3]. The likelihood of explantation by 15 years was similar for both valves (7% for the porcine valve and 8% for the pericardial valve). However, the modes of failure were different: structural valve deterioration was seen mainly in the form of a leaflet tear for porcine valves and calcification and fibrosis for pericardial valves. According to the available literature, we concur with the conclusion of Yap et al. that the bovine valve is superior in its haemodynamic profiles and has a lower rate of complications. Another advantage of the pericardial valve is the very low rate of valve thrombosis with only one case report of early bioprosthesis thrombosis in the aortic position [4]. Conflict of interest: none declared

Twelve years of experience with the ATS mechanical heart valve prostheses

The ATS Open Pivot mechanical heart valve has been implanted routinely at our institution since 1999. The objective of this study is to retrospectively analyze our 12-year clinical results with ATS prostheses. ATS Open Pivot mechanical valves were implanted in 268 adult patients between May 1999 and August 2010. We selected 259 subjects who could be adequately followed (follow-up rate 96.6%). Aortic valve replacement was performed in 157 patients, mitral valve replacement (MVR) in 71, and double (aortic and mitral) valve replacements (DVR) in 31. Mean age at the time of implant was 58.8±10.6years. The gender ratio was 128 males/131 females. Mean follow-up was 4.4±7.8years, and the cumulative follow-up was 1144 patient-years (pt-yr). Early death within 30days after the operation occurred in 5 (2.5%) patients. Late death occurred in 27 patients including valve-related deaths in 13. The 10-year survival rate after the operation was 82.7±2.9%. The rate of freedom from valve-related death was 92.2±2.2%. The incidence of valve-related complications was 2.19%/pt-yr. Of these, the incidence of thromboembolic events and that of bleeding complications were 1.22 and that 0.87%/pt-yr. The incidence of valve thrombosis was 0.09%/pt-yr. No structural valve deterioration was observed in any of the three operative procedure groups. Our 12-year experience with aortic and MVR using the ATS mechanical heart valve demonstrated low incidences of thromboembolic events, bleeding complications, and valve thrombosis.

Comparison of the Effectiveness and Safety of Low-Molecular Weight Heparin Versus Unfractionated Heparin Anticoagulation After Heart Valve Surgery

Although unfractionated heparin (UFH) is used routinely after heart valve surgery at many institutions, cardiovascular surgery patients have a particularly high risk for developing heparin-induced thrombocytopenia (HIT). The aim of this study was to compare the efficacy and safety of low-molecular-weight heparin (LMWH) or UFH after heart valve surgery by conducting a retrospective evaluation of consecutive cardiovascular surgery patients in whom the LMWH dalteparin (n = 100) was used as the postoperative anticoagulant. This group was compared to an earlier group of patients who received UFH (n = 103). The main outcomes included the efficacy of the anticoagulant regimens (determined by the incidence of valve thrombosis, arterial thromboembolic events, and venous thromboembolic events) and the safety (determined by major bleeding, HIT, thrombotic events in HIT-positive cases, and death). Overall, there were for fewer thrombotic events in the LMWH-treated group (4% vs 11%, p = 0.11). There was a higher rate of bleeding events in the UFH-treated group (10% vs 3%, p = 0.08). Six patients in the UFH-treated group developed HIT, 4 of whom had thrombotic events (HIT with thrombosis). In the LMWH-treated group, 3 patients developed HIT, 1 of whom had HIT with thrombosis. In conclusion, in this study, an LMWH regimen after heart valve surgery was effective and safe, with fewer thrombotic, bleeding, HIT, and HIT with thrombosis events.

Long-term clinical results after mitral valve replacement with the Björk-Shiley prosthesis

The experience of 810 mitral valve replacements performed during a 15-year period (1969 to June 1983) is reported. All but one patient received a Björk-Shiley disc valve. Five different Björk-Shiley models were used (Delrin, n = 51; standard pyrolytic carbon, n = 307; convexo-concave with an opening angle of 60 degrees, n = 229; convexo-concave with an opening angle of 70 degrees, n = 123; and the Monostrut valve, n = 99). The follow-up was 99.8% complete and covered 4614 patient-years (mean 6.0 years). An autopsy was performed in 77% of all fatalities. Early mortality was 5.7% and decreased during the study period. The 5-, 10-, and 15-year actuarial survival rates (early mortality excluded) were 78%, 62%, and 51%, respectively, and the complication-free survival rates at the same time intervals were 67%, 51%, and 36%. Seven percent of early deaths and 25% of late deaths were valve related, and most of these were due to valve thrombosis. The incidence of valve thrombosis was significantly (p less than 0.0005) reduced after the introduction of the convexo-concave valves, and this reduction was achieved without any increase in bleeding complications. The only patient-related factor found to be related to postoperative thromboembolism was a history of preoperative embolism (p less than 0.05). Most events occurring after implant (death, embolism, valve thrombosis, reoperation, and valve failure) had a peak incidence during the first postoperative year, whereas anticoagulant-related bleedings occurred at a constant rate of 1.2/100 patient-years. The linearized incidence of embolism was 1.6/100 patient-years (actuarial incidence at 5 and 10 years 6.9% and 13.0%, respectively). Seven strut fractures occurred (0.2/100 patient-years, actuarial incidence at 5 and 10 years 1.1%), as did five instances of prosthetic valve endocarditis (0.1/100 patient-years, actuarial incidence at 5 and 10 years, 0.7% and 1.3%). A new concept of valve failure is presented and includes a distinction between events related to the surgical procedure (treatment failure; 1.9/100 patient-years, actuarial incidence at 5 and 10 years 11.0% and 13.5%) and events possibly related to the prosthesis (prosthetic failure; 1.1/100 patient-years, actuarial incidence at 5 and 10 years 7.0% and 8.0%).

St. Jude Medical Prosthesis: Valve-Related Deaths and Complications

Despite the hemodynamic improvement in cardiac valve prostheses, valve-related deaths and complications have remained a substantial source of morbidity and mortality. This follow-up study was carried out in April, 1986, in a group of 816 patients who received 876 St. Jude Medical prostheses between October, 1977, and October, 1984. One hundred fifty-five patients (37%) of the 422 having aortic valve replacement (AVR) and 88 (29%) of the 300 having mitral valve replacement (MVR) had concomitant coronary artery bypass grafting, and 94 patients (12%) had miscellaneous procedures performed in addition to valve replacement. Sixty-three patients died within the operative period, an operative mortality of 7.7%. Follow-up was complete for 98% of the patients; the mean follow-up was 42 months. At that time, 87 more patients had died, a late mortality of 11.9%. There were 13 valve-related deaths (4 in the AVR group, 7 in the MVR group, and 2 in the miscellaneous group); the causes of death were thromboembolism (7), anticoagulant-related hemorrhage (2), valve thrombosis (2), prosthetic valve endocarditis (1), and perivalvular leak (1). There were 37 thromboembolic episodes (1.78/100 patient-years) and 67 anticoagulant-related hemorrhages (3.22/100 patient-years), 46% of which necessitated transfusion. The incidence of valve thrombosis was 0.6% (4 patients). Perivalvular leak and prosthetic valve endocarditis occurred in 7 patients (1.0%) and 5 patients (0.7%), respectively. Reoperation was carried out in 6 patients (0.8%), but only for perivalvular leak. There were no deaths, no complications, and no clinical evidence of malfunction of the prosthetic valve. The incidence of perivalvular leak, prosthetic valve endocarditis, and reoperation was rather low, and severe hemolysis occurred only in association with perivalvular leak. Thromboembolic phenomena and anticoagulant-related hemorrhage, however, have remained our major concern in spite of the favorable 7-year survival.

Measures of Prevention and Technical Problems during Reoperations in Cardiac Surgery

Reoperations after cardiac valve replacement are unavoidable: their frequency depends on surgical technique, type of valve used, and the anatomical situation. Erlangen, almost 300 such procedures were required among 3500 valve replacements, while 19 out of 700 bioprostheses had to be exchanged. Statistically relevant complications occurring with variable frequency are paravalvular leakage, thrombosis and degeneration of the bioprostheses which have to be corrected for hemodynamic reasons. Other indications are thromboembolism and endocarditis. Rare complications are: rupture of the posterior wall of the ventricle or aortic root with subsequent development of aneurysm, entrapment of the occluder due to long sutures, pannus, muscle chordae, strut fracture (Björk) or wear of the occluder (Wada, Starr, Edwards, Beall). Some complications as dehiscence, entrapment, rupture and aneurysm of the posterior wall of the ventricle and aortic root can largely be avoided by good surgical techniques. Reoperative mortality rate is slightly higher due to greater possibilities of injury and bleeding. Emergency procedures in grade IV NYHA have the highest rate (50%), elective procedures for leakage, calcified or regurgitant bioprostheses the lowest. The most frequent indication for re-operation is perivalvular leakage. Dehiscence requires surgery to deal with hemolysis or for hemodynamic reasons. Dehiscence is more common in aortic than in mitral position; the latter can be closed by felt-padded stitches in 80%. This technique is the most reliable in preventing leakage, although thrombosis is more likely. Causes of dehiscence are endocarditis, suture-line tearing, calcium in the annulus. The incidence of valve thrombosis is related to valve type, usually associated with inadequate or abruptly terminated anticoagulation therapy (rebound). Disc valve are at particular risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Evaluation of the Lillehei-Kaster Pivoting-Disc Valve

A four-year clinical evaluation of 133 patients with Lillehei-Kaster pivoting-disc valves has shown that patients with an aortic valve prosthesis have remained free from valve-related problems. Patients with a mitral valve implanted have a satisfactory survival record as calculated by actuarial methods; however, a 10% incidence of valve thrombosis was experienced. Analysis suggests that this may be related to inadequate anticoagulation or use of an inappropriate suturing technique or both. The patients enjoyed significant clinical improvement following operation, with no evidence of hemolysis. A history suggestive of postoperative embolization was present in only 1 patient in this series.