Prosthetic Valve Thrombosis: Current Management, Surgical Treatment, and the Evolution of Thrombolysis.

Long-Term Outcomes After Aortic Mechanical Valve Closure During Left Ventricular Assist Device Implantation: Comparison of "Gap-Filler" and “Sandwich” Techniques After over Six Years of Support

Immediate Postoperative Pacing Dependency Is Not Associated With Worse Mid-Term Survival in Redo Mitral Valve Surgery.

Heterograft biomaterials, such as glutaraldehyde-pretreated bovine pericardium (BP), are used to fabricate bioprosthetic heart valves (BHV). BHV durability is limited by structural valve degeneration (SVD), which is caused by either advanced glycation end products (AGE) with associated serum protein deposition, calcification, or both. Vitamin B6 vitamers have been investigated experimentally and clinically for mitigating AGE formation that complicates diabetes. In the present study, we investigated a vitamin B6-based photo-responsive molecule, Pyriphenone (PPh), hypothesizing that PPh could mitigate both BP AGE-serum protein uptake and BP calcification in vivo. PPh was synthesized by reacting pyridoxamine with benzophenone. PPh was optimally soluble in ethanol, and PPh-ethanol solutions were used for all PPh studies. PPh was demonstrated to become covalently and stably attached to BP with exposure to ultraviolet light. PPh-BP demonstrated significantly reduced in vitro AGE deposition and associated serum albumin uptake, versus unmodified BP. PPh-BP showed significant resistance to oxidation in vitro and demonstrated comparable biaxial mechanical properties to unmodified BP. In vitro hydrodynamic testing of trileaflet BHV fabricated from BP-PPh demonstrated no alterations of functionality, compared to unmodified BHV. In vivo 28-day subdermal implants in juvenile rats with either PPh-BP or unmodified BP demonstrated that PPh significantly mitigated AGE and serum albumin uptake, and calcification versus unmodified BP. Ex vivo studies of BP-PPh exposed to human whole blood demonstrated significantly reduced adhesion of platelets and white blood cells versus unmodified BP. In conclusion, PPh-BP mitigates calcification, AGE, and serum albumin uptake and reduces platelet and white blood cell adhesion. STATEMENT OF SIGNIFICANCE: Heart valve disease is highly prevalent, affecting millions. At this time, it can only be treated by either surgical valve repair or replacement of the diseased valve with a prosthesis. Bioprosthetic heart valves, fabricated from heterograft materials, are the most widely used heart valve replacements. However, these devices have poor durability due to calcification and advanced glycation end-product (AGE) deposition, which cause structural valve degeneration. Pyriphenone, the subject of this paper, is a compound synthesized by the authors that is shown in this paper to confer resistance to bioprosthetic valve calcification and AGE deposition.

Silent anticoagulation failure in children with mechanical valves in sub-Saharan Africa: implications for survival and equity.

A short history of anticoagulant therapy.

As the prevalence and technological advancements of minimally invasive heart surgery continue to increase, aortic valve replacement(AVR) via right anterolateral mini-thoracotomy (RAMT) has matured, however, problems associated with Wheat's procedure (replacement of the ascending aorta(AAR) concomitant AVR) via RAMT approach have not been reported. The objective of this study was to compare the surgical quality, postoperative outcomes, and patient safety in patients undergoing Wheat's procedure via Full sternotomy (FS) versus RAMT. A retrospective analysis was conducted on the clinical data of 163 patients who underwent Wheat procedure between January 2022 and December 2024. Out of the 163 patients, 59 underwent the Wheat procedure via a right anterior minimally invasive incision. After 1:1 propensity score matching, by comparing various intraoperative and postoperative indicators, the outcomes of patients undergoing RAMT and FS were compared. Propensity scores identified 43 patients per group with similar baseline profiles. The results from the propensity-matched cohort are as follows. Although patients in RAMT group had longer cardiopulmonary bypass (RAMT 167 ± 57 vs FS 141 ± 40min; P = 0.04) and cross-clamp (RAMT 128 ± 39 vs FS 110 ± 29min; P = 0.04) time, they experienced reduced intraoperative blood loss (RAMT 317 ± 147 vs FS 456 ± 229ml; P = 0.005). No patients in the RAMT group required intraoperative conversion to Full sternotomy. There was no statistically difference in the in-hospital mortality between the two groups (0% and 0% in RAMT and FS, respectively). RAMT was correlated with a reduced incidence of postoperative atrial fibrillation (RAMT 3 [7.0%] vs FS 13 [23.3%]; P = 0.04). Receiving RAMT can lead to a reduction in postoperative NRS pain scores and an earlier discharge for patients. RAMT not only enables shorter incisions (RAMT 6.0cm vs FS 15.2cm; P < 0.001) but also has no impact on the size or type of the artificial valve or vessel implanted, thereby ensuring that the surgical effection is non-inferior to the FS group. In the Wheat procedure, the perioperative outcomes of RAMT closely resemble those of full sternotomy, and may be transferred in the field of cardiac surgery.

Aortic stenosis is predominantly treated through transcatheter bioprosthetic heart valve implantation. However, the materials used in these devices are prone to premature failure. Polymer heart valves provide an alternative to current commercial devices, offering materials with greater durability and customisation through fibre reinforcement. Given the wide range of available materials and structures, there is a need for a systematic and efficient approach to designing and optimising novel bioinspired polymeric leaflets. This work presents a framework that employs computational modelling and Design of Experiments (DOE) tools to optimise bioinspired, 3D-printed, fibre-reinforced polymer leaflets made using melt electrowriting (MEW). Here, finite element (FE) models are created to represent MEW fibre-reinforced polymer leaflets for application in a transcatheter aortic heart valve. The behaviour of this valve under physiological loading conditions is modelled to predict valve performance and leaflet material response. These models were first used to investigate the impact of fibre orientation on valve performance and leaflet response, thereby demonstrating the benefits of a bioinspired fibre reinforcement structure. Using a DOE approach, the structural combination of MEW fibre reinforcement and an elastomeric matrix was optimised to improve valve performance and reduce leaflet stress and strain. Overall, the framework offers an efficient and versatile methodology for optimising fibre-reinforced polymer leaflets using an in silico approach, thereby reducing the need for physical prototyping and testing of these next-generation devices during early product development.

Acute coronary syndrome (ACS) following cardiac valve replacement is a rare but severe complication. Patients with vascular Ehlers-Danlos syndrome (vEDS) may exhibit an increased propensity for coronary thrombosis due to their genetic predisposition. After Bentall surgery, coronary manipulation and early postoperative anticoagulation instability may further contribute to thrombotic risk, particularly after mechanical valve implantation. A 33-year-old male presenting with acute chest pain underwent a Bentall procedure for vEDS-complicated type A aortic dissection and received postoperative anticoagulation. Twenty days postoperatively, angiography and IVUS revealed a thrombus at the left anterior descending artery (LAD) ostium. Following a multidisciplinary discussion, percutaneous coronary intervention (PCI) was successfully performed to remove the thrombus and restore blood flow. We discuss the risk of ACS following cardiac surgery, especially in vEDS patients, as well as strategies for early identification, timely intervention, and optimization of perioperative anticoagulation management.

Selecting between mechanical and bioprosthetic valves depends on multiple clinical and patient-specific criteria. This study aims to compare mechanical and bioprosthetic valve replacement outcomes in Egypt to support evidence-informed decision-making. We conducted a narrative literature review to identify studies reporting outcomes of mechanical and bioprosthetic valve replacements in Egypt. Findings were validated through an expert meeting with cardiothoracic surgeons. To capture real-world practice, an online survey was administered to cardiothoracic surgeons across Egypt. The narrative review and survey results were compared to global data to formulate recommendations on optimizing valve selection in Egypt. We extracted data from 41 eligible studies identified from the literature. Findings showed that unlike global data, reoperation rate in Egypt is lower with bioprosthetic valves compared to mechanical valves. Mechanical valves are associated with higher bleeding rates globally and locally. Survival and stroke incidence do not differ significantly between mechanical and bioprosthetic valves. The expert survey was responded to by 128 cardiothoracic surgeons. Experts predominantly used mechanical valves, highlighted age, and anticoagulation eligibility as the main factors influencing valve choice, and showed that longer clinical experience is associated with more tendency to use bioprosthetic valves. Valve type selection in Egypt should be individualized and made on a case-by-case basis due to the multiple factors influencing choice and outcomes. To support evidence-based decision-making, more local studies should be conducted, especially for bioprosthetic valves. These factors should be considered in selection to choose the most suitable valve for each patient.

Cardiac valve surgery induces systemic inflammation and variable ventricular recovery. Whether inflammatory responses differ by prosthesis type and influence clinical or functional outcomes remains unclear. In this prospective observational study, 100 adults undergoing aortic valve replacement (AVR) or mitral valve replacement (MVR) received either mechanical (n = 50) or bioprosthetic (n = 50) valves. Biochemical and inflammatory markers were measured preoperatively, on postoperative day (POD) 1, and on POD 6. Early clinical outcomes were recorded. Transthoracic echocardiography was performed at baseline and 6 months. Baseline characteristics were comparable between groups (age: 49.96 ± 9.88 years; baseline left ventricular ejection fraction [LVEF]: 48.97 ± 9.00%; EuroSCORE II: 3.64 ± 1.74). All patients exhibited a marked inflammatory surge on POD 1, with C-reactive protein increasing from 4.04 (2.83-5.33) to 59.98 (45.50-74.05) mg/L and interleukin-6 from 7.08 (5.91-8.28) to 118.53 (95.25-141.06) pg/mL, followed by partial normalization by day 6 (all P < 0.001). Inflammatory trajectories did not differ by prosthesis type. Early outcomes included atrial fibrillation in 32%, acute kidney injury in 16.0%, and 30-day mortality in 6.0%, without significant valve-group differences. At 6 months, mechanical valves demonstrated lower mean transvalvular gradients (5.77 ± 4.69 vs. 10.20 ± 5.18 mmHg; P = 0.001) and greater improvement in LVEF (ΔLVEF: 5.68 ± 2.99 vs. 3.83 ± 3.08%; P = 0.003). AVR (β = 2.80; P < 0.001) and mechanical prostheses (β = 2.50; P < 0.001) independently predicted greater ΔLVEF. Serum lactate predicted 30-day mortality (area under the curve: 0.846). Perioperative inflammation is substantial but transient and unrelated to prosthesis type. Functional recovery is driven by valve position and prosthesis hemodynamics, with mechanical AVR conferring superior mid-term ventricular improvement.

Comparing perioperative heparin bridging strategies in mechanical heart valve patients undergoing surgery: A systematic review and Bayesian meta-analysis.

A dual-crosslinking modification strategy as an alternative to glutaraldehyde for preparing valve materials.

Structural valve degeneration (SVD) is a key limitation of bioprosthetic heart valves (BHVs). The underlying mechanisms for this degeneration and pathophysiology remains only partially defined. Emerging evidence implicates a xenogeneic carbohydrate epitope, galactose-α-1,3-galactose (Alpha-gal), as a potential driver of immune-mediated valve deterioration. This review explores the current knowledge on alpha-gal (AG) sensitization and evidence linking it to SVD and the potential clinical implications. A literature search was conducted using Embase, PubMed and Scopus, using variants of the following keywords, such as "alpha-gal", "bioprosthetic valve", and "degeneration". Studies included reported human subject findings and focused on BHVs. Only original works were permitted, published between January 2014 and December 2025. Six studies met the inclusion criteria. Case reports demonstrated heterogenous clinical outcomes with, rapid SVD observed in some alpha-gal sensitized patients, while other patients showed tolerance to bioprosthetic implantation in the perioperative and short-term period. The only study with longitudinal follow-up demonstrated that anti-AG IgG responses were associated with increased SVD and calcification. Another study found no perioperative adverse valvular outcomes, although follow-up was limited to in-hospital assessment. Overall, his manuscript identifies that AG sensitization may contribute to SVD in certain patients, however, its broader significance remains uncertain. Immune recognition of AG may contribute to SVD based on the limited available evidence. Larger prospective investigations are required to clarify a causal relationship and to assist in guiding potential preventative strategies. Recognition of this mechanism may ultimately inform management of valve replacement and bioprosthesis selection plans.

This article reviews the perioperative management of adults with heart valve disease undergoing noncardiac surgery. It focuses on aortic and mitral valve disease, as well as prosthetic heart valves, in the context of the substantial hemodynamic challenges imposed by anesthesia during major surgery. We aim to integrate guideline-based recommendations for preoperative evaluation and risk stratification with pathophysiological principles to support individualized intraoperative hemodynamic and anesthetic management. Current literature and guidelines converge on symptom status and echocardiographic severity as key determinants of perioperative risk. For stenotic lesions, maintaining sinus rhythm, avoiding tachycardia, preserving preload, and preventing abrupt afterload reduction are central intraoperative goals. For regurgitant lesions, strategies that support forward flow by avoiding bradycardia and excessive afterload are emphasized. In prosthetic valves, perioperative management is driven by valve type/position and thromboembolic risk, guiding anticoagulation interruption and bridging, while endocarditis prophylaxis is reserved for selected high-risk dental procedures. A practical approach integrates surgical urgency, valve severity, symptoms, ventricular function, and pulmonary pressures to determine whether to proceed with surgery, optimize medically, or to perform valve intervention first, and to tailor intraoperative monitoring and anticoagulation plans.

Mechanical prosthetic heart valve implantation is a widely used surgical treatment for severe symptomatic valvular heart disease, and regular follow-up of prosthetic valve function together with associated clinical and laboratory parameters is essential after implantation. Chronic subclinical intravascular hemolysis is frequently observed in this population; however, its long-term clinical implications remain incompletely defined. In this single-center, retrospective, non-randomized cohort study, 346 patients who underwent aortic and/or mitral mechanical valve replacement and met predefined inclusion and exclusion criteria were evaluated to investigate the association between subclinical hemolysis severity-assessed by follow-up serum lactate dehydrogenase (LDH) levels-and endothelial dysfunction-related clinical outcomes, includin pulmonary hypertension (PHT) and major adverse cardiovascular events (MACE). Mechanical intravascular hemolysis severity was stratified according to the median follow-up LDH (fLDH) value of 264.5 U/L, categorizing patients into non-/mild hemolysis (Group 1) and moderate hemolysis (Group 2). The mean age of the cohort was 57.5 ± 12.5 years, 65% were male, and traditional coronary artery disease risk factors were similarly distributed between groups. Over a mean follow-up duration of 9.4 ± 3.3 years 18 MACE events (5.2%) were observed, while new-onset PHT developed in 122 patients (35.3%). MACE occurred in 1 patient (0.6%) in Group 1 and in 17 patients (9.8%) in Group 2 (p < 0.001). In multivariable logistic regression analysis, an fLDH level ≥ 265 U/L and the presence of diabetes mellitus were associated with MACE, although effect size estimates were accompanied by wide confidence intervals due to the limited number of events. Overall, higher levels of subclinical intravascular hemolysis, reflected by elevated LDH, were associated with an increased occurrence of MACE and PHT in patients with mechanical prosthetic heart valves. Given the low eventcount and resulting statistical uncertainty, these findings should be interpreted as exploratory and hypothesis-generating rather than causal, and larger prospective studies are warranted to clarify the prognostic significance of subclinical hemolysis and its potential role in long-term risk stratification.

Frozen phase separation-fabricated bacterial nanocellulose/polyvinyl alcohol dual-network hydrogel membranes with enhanced mechanical properties and anti-calcification for artificial heart valves.

Radiology: Cardiothoracic Imaging publishes novel research and technical developments in cardiac, thoracic, and vascular imaging. This review article, led by the Radiology: Cardiothoracic Imaging Early Career Editorial Board, highlights selected articles published in the journal between November 2024 and October 2025. Featured articles span the breadth of cardiothoracic and vascular imaging, including cardiac CT assessment of prosthetic heart valves, photon-counting CT for improved coronary stent evaluation, and streamlined multiparametric cardiac MRI acquisition techniques. Additional topics include imaging of mitral annular disjunction; cardiac MRI markers of diastolic dysfunction, myocardial heterogeneity, and myocarditis prognosis; and cardiac MRI-based assessment of sarcopenia as a novel prognostic marker. Ongoing research and future directions include accelerated cardiac MRI, opportunistic cardiovascular risk assessment from incidental findings at routine imaging, and expanding applications of quantitative and artificial intelligence-driven techniques across cardiac, thoracic, oncologic, and vascular imaging. Keywords: Deep Learning, CT, CT-Coronary Angiography, CT Angiography, CT-Photon Counting, CT-Quantitative, Aorta, Coronary Arteries, Clinical Testing, MR Imaging, MRI, Cardiac, Pulmonary, Heart, Lung, Artificial Intelligence, Mitral Valve, Thoracic Tumor Staging, Vascular © RSNA, 2026.

A 6‐year‐old male patient with pulmonary atresia and recent valve replacement with a Melody valve presented with a 6‐week history of fever and cough. He was diagnosed with Coxiella burnetii endocarditis based on a C. burnetii Phase I IgG antibody titre of 1:65,536 and increased metabolic activity surrounding his prosthetic cardiac valve on positron emission tomography scan. Treatment was initiated with doxycycline and hydroxychloroquine. However, despite dose escalation, target plasma concentrations were not achieved. The patient experienced rapid clinical improvement, and serological markers declined gradually. Antimicrobial therapy was discontinued after 40 months, as predefined serological criteria were met, clinical course was favourable, and a follow‐up positron emission tomography scan demonstrated a significant reduction in metabolic activity around the prosthetic valve. Up to 23 months after cessation of therapy, the patient showed no evidence of active C. burnetii endocarditis during follow‐up. The Melody valve maintained its function, and valve replacement was not required. Clinicians should employ an individualised treatment approach to children with C. burnetii endocarditis.

BackgroundThere is limited information on rheumatic mitral valve surgery for children living in low- and middle-income African countries.Patients and methodsFrom 1/1/1998 to 1/1/2024, a total of 276 children <18 years of age, coming from Africa, underwent mitral valve (MV) surgery in France. The majority of the patients were in New York Heart Association (NYHA) class III. Mécénat Chirurgie Cardiaque operates in France on children with pediatric cardiac diseases. There were 28 patients who had insertion of a bioprosthetic MV (BioV), 91 patients had placement of a mechanical mitral valve (MechV), and 157 patients had MV repair (MV repair).ResultsThe in hospital mortality was 1.1% (3/276). There were 37 patients lost to follow-up. The overall mortality on patients with follow up was to 33% (78/239) : 71% (20/28) for BioV (P < .0001), 30% (24/81) for MechV and 26% (34/130) for MV repair. The actuarial survival at 20 years was similar for MechV and MV repair, 70% and 68%, respectively (P=ns). Follow-up was available for 83.7% of the patients and extended over 20 years; follow up was 95% in the last 13 years. MV repair demonstrated superior outcome during the first 15 years (P= .031). MechV had a higher mortality during the first 15 years due to complications of anticoagulation, but did not require reoperation and had a flat survival curve after 15 years.ConclusionRheumatic MV surgery has a high mortality in the least developed African countries. Bioprosthetic mitral valve replacement was demonstrated to be a very high risk strategy. Patients undergoing mechanical valve operation had poor results due to anticoagulation. MV repair was the best surgical strategy when feasible, particularly in young children who can enjoy a better quality of life until adulthood,despite the risk of reoperation and the need for antibiotics.