Outcomes of Warfarin Therapy for Bioprosthetic Valve Thrombosis of Surgically Implanted Valves

Egbe, Alexander C.; Connolly, Heidi M.; Pellikka, Patricia A.; Schaff, Hartzell V.; Hanna, Richard D.; Maleszewski, Joseph J.; Nkomo, Vuyisile T.; Pislaru, Sorin V.

doi:10.1016/j.jcin.2016.11.027

Cited by 58 publications

(42 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Egbe et al 30 performed a prospective trial of anticoagulation with warfarin (target international normalised ratio 2 to 3) in patients with suspected bioprosthetic valve thrombosis. This strategy reduced valve gradients in 83% of the cohort (response defined as 50% reduction in valve gradient) within a median time of 11 weeks.…”

Section: Managementmentioning

confidence: 99%

Mechanical and surgical bioprosthetic valve thrombosis

Lim

Lloyd

2017

Heart

View full text Add to dashboard Cite

Valve thrombosis can occur in mechanical prosthetic valves and is increasingly recognised in transcatheter and surgically implanted bioprosthetic valves. The risk of thrombosis of mechanical valves is higher in the mitral position compared with aortic position and in older generation valves (ball and cage valves). There is a wide spectrum of presentation from the asymptomatic patient to those with embolic complications or cardiogenic shock. A combination of transthoracic and transesophageal echocardiography is required to assess the haemodynamic effect of thrombosis (valve gradients and area), leaflet motion and thrombus size. CT or cinefluoroscopy may be useful in selected cases to assess leaflet motion or help identify the aetiology of valve obstruction where echocardiography is inconclusive. Exclusion of pannus or vegetation is important. Management of non-obstructive thrombus is primarily optimisation of anti-coagulation. Treatment of obstructive thrombus requires a decision between slow, low-dose fibrinolysis or valve surgery. Factors which need to be considered include thrombus size, New York Heart Association Class, presence of concomitant coronary artery disease or other valve dysfunction, surgical risk and contraindication to fibrinolysis. This review examines the incidence, aetiology, clinical features, imaging algorithms and management of prosthetic valve thrombosis.

show abstract

Section: Managementmentioning

confidence: 99%

Mechanical and surgical bioprosthetic valve thrombosis

Lim

Lloyd

2017

Heart

View full text Add to dashboard Cite

show abstract

“…Several studies have reported successful resolution of BPVT when treated with VKA (vitamin K antagonist) 5678 . A prospective evaluation of warfarin showed that anticoagulation was effective in 83% of patients with suspected BPVT, and most responded within 3 months 7 . A recent study by Petrescu et al reported long term outcomes of anticoagulation in 83 patients treated with warfarin for suspected BPVT.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Bioprosthetic Mitral Valve Thrombosis Treated with Anticoagulation

Fernandes¹,

Varshney

Aragam³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…1 In a prospective trial of 52 patients with suspected BPVT, warfarin therapy for 3 months reduced the prosthesis gradient by at least half in 83% of the patients. 4 Echocardiography is a key tool for diagnosing prosthetic valve stenosis; however, guidelines state that routine monitoring of bioprosthetic valves by means of annual TTE should begin 10 years after implantation. 5 Some investigators have called for annual TTE screening 2,6 because the peak incidence of BPVT may occur during the first 1 to 2 years after valve implantation.…”

Section: Discussionmentioning

confidence: 99%

Use of Computed Tomography to Distinguish Thrombus from Pannus on a Bioprosthetic Aortic Valve

Kealhofer

Markowitz

Nijjar

2019

Texas Heart Institute Journal

View full text Add to dashboard Cite

Bioprosthetic valve thrombosis was previously considered to be a relatively rare complication of surgical or transcatheter bioprosthetic valve replacement. Although echocardiograms can reliably show the characteristic findings of prosthetic valve stenosis, differentiating between thrombus formation and pannus overgrowth as the underlying cause of prosthetic valve dysfunction can be challenging. We present the case of a 75-year-old man who underwent transthoracic Doppler echocardiography in the presence of an elevated valvular gradient 2 years after his aortic valve had been surgically replaced with a bioprosthesis. The echocardiographic findings suggested prosthetic valve stenosis. Cardiac computed tomography, performed to distinguish between thrombus formation and pannus overgrowth, revealed hypoattenuated leaflet thickening and reduced leaflet mobility, which suggested thrombus. After the patient took oral anticoagulants for 3 months, images showed complete resolution of the previous abnormalities, thus confirming the diagnosis of bioprosthetic valve thrombosis. We found cardiac computed tomography valuable when evaluating our patient who had an elevated prosthetic valve gradient.

show abstract

Outcomes of Warfarin Therapy for Bioprosthetic Valve Thrombosis of Surgically Implanted Valves

Abstract: A trial of anticoagulation was effective in 83% of patients with suspected BPVT, and most patients responded within 3 months. BPVT score was predictive of response to therapy and should be considered during patient selection.

Cited by 58 publications

References 16 publications

Mechanical and surgical bioprosthetic valve thrombosis

Mechanical and surgical bioprosthetic valve thrombosis

Recurrent Bioprosthetic Mitral Valve Thrombosis Treated with Anticoagulation

Use of Computed Tomography to Distinguish Thrombus from Pannus on a Bioprosthetic Aortic Valve

Contact Info

Product

Resources

About