Complications of prosthetic heart valves

Abstract

Treatment of native valvular heart disease has resulted in an increasing number of patients with prosthetic valves. Although an improvement over the diseased native valve removed at surgery, prosthetic valves have suboptimal hemodynamics; mechanical valves require anticoagulation and tissue valves wear out over time. Serious complications of prosthetic valves occur at a rate of about 2% to 3% per patient-year. Complications include thromboembolism, prosthesis-patient mismatch, structural valve dysfunction, endocarditis, and hemolysis. Prosthetic valve endocarditis is a lethal disease with mortality rates of 50% to 80% even with appropriate therapy. Echocardiography now provides detailed information on valve function and hemodynamics, allowing early detection of complications. Many of these complications can be prevented by choosing the optimal valve at the time of surgery, rigorous control of anticoagulation and adherence to established anticoagulation guidelines, dental hygiene and endocarditis prophylaxis, and periodic echocardiographic monitoring by a cardiologist.

Transcatheter Aortic Valve Replacement for Bioprosthetic Aortic Valve Failure

“…19 In the Global Valve-in-Valve Registry, 42% of patients had predominant stenosis, 34% had predominant regurgitation, and 24% had both important stenosis and regurgitation.…”

Prosthetic Heart Valves

“…6,50 The risk of thromboembolic complications is similar for patients with mechanical valves on warfarin therapy and bioprosthetic valves without warfarin therapy. The risk of thromboembolism depends not only on prosthesis type but also on valve position and thrombogenicity, patient risk factors, and antithrombotic treatment.…”

“…The incidence of obstructive valve thrombosis varies between 0.3% and 1.3% per patient-year in patients with mechanical valves. 50,63 Diagnosis Valve thrombosis should be suspected in any patient with any type of prosthetic valve who presents with a recent increase in dyspnea or fatigue because valve thrombosis can develop gradually and insidiously over several days or weeks. 9 Suspicion should be higher if there has been a period of interrupted or subtherapeutic anticoagulation in the recent past.…”

“…50,64 Randomized comparative studies of bioprosthetic versus mechanical prostheses reported that thromboembolism rates are similar with the 2 types of valves but bleeding is more common with a mechanical valve. 64,65 In patients with mechanical valves, the bleeding events are most often due to excessive anticoagulation, which can be managed by withholding warfarin and monitoring the level of anticoagulation with serial INR determinations.…”

Aorto–left atrial fistula, the role of transesophageal echocardiography: a case report.

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Endocarditis represents a major complication of prosthetic heart valves, with estimated mortality rates of 50% to 80% even with appropriate therapy 1 . Prosthetic endocarditis occurs in approximately 2%-4% of patients, mainly in the first months after surgery 2 .

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