Frequency and severity of intravascular hemolysis after left-sided cardiac valve replacement with medtronic hall and St. Jude medical prostheses, and influence of prosthetic type, position, size and number

Skoularigis, John; Essop, Mohammed R.; Skudicky, Daniel; Middlemost, Shirley; Sareli, Pinhas

doi:10.1016/0002-9149(93)90516-f

Cited by 74 publications

(52 citation statements)

References 16 publications

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“…2,6,7,10) On the other hand, several markers including increased reticulocyte count, schistocyte count, and serum lactate dehydrogenase, or reduced haptoglobin have been applied to estimate the severity of intravascular hemolysis. 1,2,6,7,[18][19][20][21][22][23][24] Among these markers, serum lactate dehydrogenase has been widely used to estimate the severity of intravascular hemolysis in patients with cardiac valve prostheses, because a close relation between serum lactate dehydrogenase and half-life of 51 Crlabeled erythrocytes was demonstrated in patients with cardiac valve prostheses.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

et al. 2016

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SummaryChronic intravascular hemolysis has been identified in patients with cardiac valve prostheses, but only a few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. To detect intravascular hemolysis in patients with aortic stenosis, erythrocyte creatine was evaluated with hemodynamic indices obtained by echocardiography.Erythrocyte creatine, a marker of erythrocyte age, was assayed in 30 patients with aortic stenosis and 10 aged matched healthy volunteers. Peak flow velocity of the aortic valve was determined by continuous-wave Doppler echocardiography. Twenty of 30 patients with aortic stenosis had high erythrocyte creatine levels (> 1.8 µmol/g Hb) and erythrocyte creatine was significantly higher as compared with control subjects (1.98 ± 0.49 versus 1.52 ± 0.19 µmol/g Hb, P = 0.007). Peak transvalvular pressure gradient ranged from 46 to 142 mmHg and peak flow velocity ranged from 3.40 to 5.95 m/second. Patients with aortic stenosis had a significantly lower erythrocyte count (387 ± 40 versus 436 ± 42 × 10 4 µL, P = 0.002) and hemoglobin (119 ± 11 versus 135 ± 11 g/L, P < 0.001) as compared with control subjects. Erythrocyte creatine had a fair correlation with peak flow velocity (r = 0.55, P = 0.002).In conclusion, intravascular hemolysis due to destruction of erythrocytes was detected in patients with moderate to severe aortic stenosis and the severity of intravascular hemolysis was related to valvular flow velocity of the aortic valve. (Int Heart J 2016; 57: 430-433)

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Section: Discussionmentioning

confidence: 99%

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

et al. 2016

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“…In a later study, Dale et al 9 found a correlation between elevated levels of the enzyme lactate dehydrogenase (LDH) and decreased red cell half-life in patients with first-generation prosthetic heart valves. Skoularigis et al 29 evaluated hemolysis in 170 patients with St. Jude Medical bileaflet mechanical valves and in 80 patients with Medtronic-Hall tilting disc valves. The presence and severity of hemolysis in these patients were correlated with elevated concentrations of serum LDH, serum haptoglobin, and blood hemoglobin.…”

Section: The Link Between Hemodynamics and Clinical Complicationsmentioning

confidence: 99%

Flow in Prosthetic Heart Valves: State-of-the-Art and Future Directions

2005

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Since the first successful implantation of a prosthetic heart valve four decades ago, over 50 different designs have been developed including both mechanical and bioprosthetic valves. Today, the most widely implanted design is the mechanical bileaflet, with over 170,000 implants worldwide each year. Several different mechanical valves are currently available and many of them have good bulk forward flow hemodynamics, with lower transvalvular pressure drops, larger effective orifice areas, and fewer regions of forward flow stasis than their earlier-generation counterparts such as the ball-and-cage and tilting-disc valves. However, mechanical valve implants suffer from complications resulting from thrombus deposition and patients implanted with these valves need to be under long-term anti-coagulant therapy. In general, blood thinners are not needed with bioprosthetic implants, but tissue valves suffer from structural failure with, an average life-time of 10-12 years, before replacement is needed. Flow-induced stresses on the formed elements in blood have been implicated in thrombus initiation within the mechanical valve prostheses. Regions of stress concentration on the leaflets during the complex motion of the leaflets have been implicated with structural failure of the leaflets with bioprosthetic valves. In vivo and in vitro experimental studies have yielded valuable information on the relationship between hemodynamic stresses and the problems associated with the implants. More recently, Computational Fluid Dynamics (CFD) has emerged as a promising tool, which, alongside experimentation, can yield insights of unprecedented detail into the hemodynamics of prosthetic heart valves. For CFD to realize its full potential, however, it must rely on numerical techniques that can handle the enormous geometrical complexities of prosthetic devices with spatial and temporal resolution sufficiently high to accurately capture all hemodynamically relevant scales of motion. Such algorithms do not exist today and their development should be a major research priority. For CFD to further gain the confidence of valve designers and medical practitioners it must also undergo comprehensive validation with experimental data. Such validation requires the use of high-resolution flow measuring tools and techniques and the integration of experimental studies with CFD modeling.

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“…Previous animal and clinical studies have revealed that thromboembolic complication rates are higher for valves implanted in the mitral position. 2,8,11,14 Therefore, clinical reports indicate that mechanical valves implanted in the aortic position have better performances than those implanted in the mitral position.…”

Section: Dependence On Implant Locationmentioning

confidence: 99%

Comparison of the Hinge Flow Fields of Two Bileaflet Mechanical Heart Valves under Aortic and Mitral Conditions

et al. 2004

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Aortic and mitral flow patterns within the two hinges were similar, but with a more dynamic flow during the forward flow phase under aortic conditions. Velocity magnitudes and shear stresses measured under mitral conditions were generally higher than those obtained in the aortic position, which may explain the higher rates of thromboembolism in the mitral implants when compared with the aortic implants.

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Frequency and severity of intravascular hemolysis after left-sided cardiac valve replacement with medtronic hall and St. Jude medical prostheses, and influence of prosthetic type, position, size and number

Cited by 74 publications

References 16 publications

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

Flow in Prosthetic Heart Valves: State-of-the-Art and Future Directions

Comparison of the Hinge Flow Fields of Two Bileaflet Mechanical Heart Valves under Aortic and Mitral Conditions

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