Index of deterioration of patients with mechanical prosthetic heart valve thrombosis

Abstract

Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Results The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05). ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities. Conclusion The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.

Early Outcomes of Emergency Surgery for Left-Sided Mechanical Valve Thrombosis

“…The advanced stage in our patient group is evident by the high percentage of patients in NYHA class IV (80.4%), the percentage of patients requiring preoperative ventilation (11.3%), and the fact that they were not considered candidates for thrombolysis due to a high thrombotic burden. Other authors reporting better survival rates not only included more hemodynamically stable patients, but also reported only operative mortality rather than total inhospital mortality [Ahn 2008;Hassouna 2020].…”

“…Most of the published reports about MVT included heterogeneous groups of patients undergoing surgery with variable degrees of urgency [Durrleman 2004;Ahn 2008;Ma 2015;Roudaut 2003;Hassouna 2020]. Older reports including only patients who underwent emergency surgery included mostly older generations of mechanical valves like tilting disc and ball & cage valves, apart from reporting from a different clinical setup where mechanical valves are less commonly used [Buttard 1997].…”

The medical community mourns Professor Dr. Ahmed Hassouna, the renowned editor of The Cardiothoracic Surgeon journal (1957–2024)

“…His contributions to the journal will forever be remembered as a significant milestone in cardiothoracic surgery and a testament to his outstanding leadership and commitment to advancing medical research. Moreover, The Cardiothoracic Surgeon journal witnessed the publication of the last original research of Prof. Hassouna [2] before dedicating his time to education and book authorship. In a testament to his unwavering dedication, Prof. Hassouna tirelessly served the journal until his final breath, meticulously processing articles mere hours before his passing [3,4].…”

Diagnostic Value of D-Dimer and INR in Patients Suspected to Have Prosthetic Valve Dysfunction

“…Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement [ 1 , 2 ] . An easy and quickly applicable diagnostic procedure is required for recognizing the prosthetic valve dysfunction.…”