Hemolysis Associated With Prosthetic Heart Valves

Abstract

Hemolysis is one of the potentially serious complications of prosthetic heart valves. It is usually associated with either structural deterioration or paravalvular leak. Mild, compensated hemolysis associated with mechanical heart valves is not uncommon even in the current era. Severe hemolysis is rare, however, and usually reflects paravalvular leak. The use of transesophageal echocardiography-guided operative techniques may help prevent or minimize early postoperative paravalvular leakage. There is a gamut of available therapeutic approaches-medical, transcatheter, and surgical-to this complication and therapy should be tailored to the individual patient. Novel pharmacological agents include erythropoietin and pentoxifylline. Several reports described the feasibility of transcatheter closure of paravalvular leak with coils or devices, but their effect on hemolysis is unpredictable. Surgery remains the treatment of choice in severe cases.

Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

“…This might be owing to the fact that we avoided the continuous suture technique, which has proved to be associated with a high incidence of PVL after MVR [2,7]. In addition to suture technique, previous studies suggested that the presence of heavy annular calcification, small body surface area, and size and type of prosthetic valve were associated with mitral PVL [1,2,[7][8][9][10]. In the present study, however, we could not demonstrate that such factors are associated with incidence of mitral PVL.…”

Pathology of Transcatheter Valve Therapy

“…Despite a significantly higher incidence of trivial to moderate paravalvular leaks in patients after transcatheter valve implantation as compared to surgical patients, transcatheter valve patients have significantly better hemodynamics and improvement of left ventricular function (35)(36)(37). Whether paravalvular leaks after TAVI result in (clinically relevant) hemolysis (as described from surgical collectives (38)) needs further investigation.…”

The Challenge of the Use of Glycemic Biomarkers in Diabetes: Reflecting on Hemoglobin A1C, 1,5-Anhydroglucitol, and the Glycated Proteins Fructosamine and Glycated Albumin

“…RBCs that have a short lifespan secondary to destruction (i.e., hemolytic anemia, 17 destruction through the passage of abnormal heart valves, 18 or splenomegaly) will result in a low A1C independent of the mean serum glucose. This situation is also present in circumstances in which the bone marrow increases the production of young RBCs (reticulocytes), as seen in patients with chronic kidney disease (CKD) who receive erythropoietin treatment for anemia; post-hemorrhage, as the healthy bone marrow is stimulated by hypoxia; or after a blood transfusion.…”