Obstructions of prosthetic heart valves: diagnosis and treatment considerations

Mehmet Nuri Karabulut; Rafet Günay; Mahmut Murat Demirtaş

doi:10.18621/eurj.1429266

Araştırma Makalesi

Obstructions of prosthetic heart valves: diagnosis and treatment considerations

Yıl 2024, EARLY ONLINE, 1 - 10

Mehmet Nuri Karabulut Rafet Günay Mahmut Murat Demirtaş

https://doi.org/10.18621/eurj.1429266

Öz

Objectives: Since the first years of native heart valve replacement by - prosthetic valves; prosthesis thrombogenicity has kept its importance as a serious problem causing post-operative morbidities and mortality. This study aims to evaluate early postoperative morbidity and mortality of patients diagnosed with prosthetic valve thrombosis and treated surgically or non-surgically.

Methods: Thirty-one patients diagnosed with and treated for prosthetic valve thrombosis were evaluated retrospectively. The patients were followed up for 58 months.

Results: There were 24 females and 7 males. The mean patient age at the time of prosthetic valve thrombosis diagnosis was 40.7±11 (range, 10-57) years. The mean duration between prosthetic valve replacement and the first signs of prosthetic valve thrombosis was 67.67±66 (range, 1 to 300) months. All patients presented with a functional capacity of NYHA Class III or IV. A total of 32 interventions; 27 surgical and 5 thrombolytic treatments due to elevated aortic prosthetic valve pressure gradient which did not improve with thrombolysis. Of 27 surgical interventions for thrombosed prosthetic valves, 21 involved mitral, 2 aortic, and 4 tricuspid positions. A total of 9 patients died during follow-up. The overall mortality rate was 29.03%. The mortality rate was 29.62% after surgical interventions and 20% after thrombolytic treatment.

Conclusion: Currently prosthetic valve replacement is the basic palliation method in the management of patients with diseased native heart valves. In the majority of mechanical prosthetic valve obstructions, the main pathology is fibrous tissue proliferation-related to irregular warfarin usage, which in turn causes the development of acute symptoms secondary to acute valve thrombosis. The necessary treatment method for prosthetic valve obstructions should be either the use of thrombolytic agents or the replacement of the obstructed prosthetic valve with a new one.

Anahtar Kelimeler

Obstructions, prosthetic heart valves, treatment

Kaynakça

1. Starr A, Edwards ML. Mitral replacement: clinical experience with a ball-valve prosthesis. Ann Surg. 1961;154(4):726-740. doi: 10.1097/00000658-196110000-00017.
2. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-142. doi: 10.1136/hrt.2005.071183.
3. Roe B. ‘‘Extinct’’ cardiac valve prostheses. In: Bodnar E, Frater RWM (Eds): Replacement Cardiac Valves. 1st ed., Pergamon Press: New York, 1991; pp. 307-332.
4. Gott VL, Koepke DE, Dagget RL, Zarnstorrf W, Young WP. The coating of intravascular plastic prostheses with colloidal graphite. Surgery. 1961;50(8):382-386.
5. Bokros JC, La Grange LD, Schoen FJ. Control of structure of carbon for use in bioengineering: In Walker PL(ed): Chemistry and Physics of Carbon. Dekker: New York, 1973; pp. 103-121.
6. Horstkotte D, Burckhardt D. Prosthetic valve thrombosis. J Heart Valve Dis. 1995;4(2):141-153.
7. Toker ME, Eren E, Balkanay M, et al. Multivariate analysis for operative mortality in obstructive prosthetic valve dysfunction due to pannus and thrombus formation. Int Heart J. 2006;47(2):237-245. doi: 10.1536/ihj.47.237.
8. Masri Z, Girardet R, Attum A, Barbie R, Yared I, Lansing A. Reoperation for prosthetic heart valve dysfunction. Tex Heart Inst J. 1990;17(2):106-111.
9. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol. 1991;17(3):646-650. doi: 10.1016/s0735-1097(10)80178-0.
10. Vitale N, Renzulli A, Cerasuolo F, et al. Prosthetic valve obstruction: thrombolysis versus operation. Ann Thorac Surg. 1994;57(2):365-370. doi: 10.1016/0003-4975(94)90998-9.
11. Renzulli A, De Luca L, Caruso A, Verde R, Galzerano D, Cotrufo M. Acute thrombosis of prosthetic valves: a multivariate analysis of the risk factors for a life threatening event. Eur J Cardiothorac Surg. 1992;6(8):412-420. doi: 10.1016/1010-7940(92)90065-6.
12. Antunes MJ. Fate of thrombectomized Björk-Shiley valves. J Thorac Cardiovasc Surg. 1986;92(5):965-966.
13. Edmunds LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg. 1987;44(4):430-445. doi: 10.1016/s0003-4975(10)63816-7.
14. Venugopal P, Kaul U, Iyer KS, et al. Fate of thrombectomized Björk-Shiley valves. A long-term cinefluoroscopic, echocardiographic, and hemodynamic evaluation. J Thorac Cardiovasc Surg. 1986;91(2):168-173.
15. Yoganathan AP, Corcoran WH, Harrison EC, Carl JR. The Björk-Shiley aortic prosthesis: flow characteristics, thrombus formation, and tissue overgrowth. Circulation. 1978;58(1):70-76. doi: 10.1161/01.cir.58.1.70.
16. Kontos GJ Jr, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Ann Thorac Surg. 1989;48(1):60-65. doi: 10.1016/0003-4975(89)90177-x.
17. Graver LM, Gelber PM, Tyras DH. The risks and benefits of thrombolytic therapy in acute aortic and mitral prosthetic valve dysfunction: report of a case and review of the literature. Ann Thorac Surg. 1988;46(1):85-88. doi: 10.1016/s0003-4975(10)65859-6.
18. Ledain LD, Ohayon JP, Colle JP, Lorient-Roudaut FM, Roudaut RP, Besse PM. Acute thrombotic obstruction with disc valve prostheses: diagnostic considerations and fibrinolytic treatment. J Am Coll Cardiol. 1986;7(4):743-751. doi: 10.1016/s0735-1097(86)80331-x.
19. Roudaut R, Labbe T, Lorient-Roudaut MF, et al. Mechanical cardiac valve thrombosis: Is fibrinolysis justified? Circulation. 1992;86(5 Suppl):II8-15.
20. Pradhan A, Bhandari M, Gupta V, et al. Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients with Prosthetic Valve Thrombosis: A Single-Center Experience. Cardiol Res. 2019;10(6):345-349. doi: 10.14740/cr924.
21. Jones JM, O'kane H, Gladstone DJ, et al. Repeat heart valve surgery: risk factors for operative mortality. J Thorac Cardiovasc Surg. 2001;122(5):913-918. doi: 10.1067/mtc.2001.116470.
22. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-142. doi: 10.1136/hrt.2005.071183.
23. Onorati F, Perrotti A, Reichart D, et al. Surgical factors and complications affecting hospital outcome in redo mitral surgery: insights from a multicentre experience. Eur J Cardiothorac Surg. 2016;49(5):e127-133. doi: 10.1093/ejcts/ezw048.
24. Russo M, Taramasso M, Guidotti A, et al. The evolution of surgical valves. Cardiovasc Med. 2017;20(12):285-292. doi: 10.4414/CVM.2017.00532
25. Kim YW, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Outcomes of Reoperative Valve Replacement in Patients with Prosthetic Valve Endocarditis: A 20-Year Experience. Korean J Thorac Cardiovasc Surg. 2018;51(1):15-21. doi: 10.5090/kjtcs.2018.51.1.15.
26. Kilic A, Acker MA, Gleason TG, et al. Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2019;107(3):754-759. doi: 10.1016/j.athoracsur.2018.08.083.
27. Tatsuishi W, Kumamaru H, Nakano K, Miyata H, Motomura N. Evaluation of postoperative outcomes of valve reoperation: a retrospective study. Eur J Cardiothorac Surg. 2021;59(4):869-877. doi: 10.1093/ejcts/ezaa384.

Yıl 2024, EARLY ONLINE, 1 - 10

Mehmet Nuri Karabulut Rafet Günay Mahmut Murat Demirtaş

https://doi.org/10.18621/eurj.1429266

Öz

Kaynakça

1. Starr A, Edwards ML. Mitral replacement: clinical experience with a ball-valve prosthesis. Ann Surg. 1961;154(4):726-740. doi: 10.1097/00000658-196110000-00017.
2. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-142. doi: 10.1136/hrt.2005.071183.
3. Roe B. ‘‘Extinct’’ cardiac valve prostheses. In: Bodnar E, Frater RWM (Eds): Replacement Cardiac Valves. 1st ed., Pergamon Press: New York, 1991; pp. 307-332.
4. Gott VL, Koepke DE, Dagget RL, Zarnstorrf W, Young WP. The coating of intravascular plastic prostheses with colloidal graphite. Surgery. 1961;50(8):382-386.
5. Bokros JC, La Grange LD, Schoen FJ. Control of structure of carbon for use in bioengineering: In Walker PL(ed): Chemistry and Physics of Carbon. Dekker: New York, 1973; pp. 103-121.
6. Horstkotte D, Burckhardt D. Prosthetic valve thrombosis. J Heart Valve Dis. 1995;4(2):141-153.
7. Toker ME, Eren E, Balkanay M, et al. Multivariate analysis for operative mortality in obstructive prosthetic valve dysfunction due to pannus and thrombus formation. Int Heart J. 2006;47(2):237-245. doi: 10.1536/ihj.47.237.
8. Masri Z, Girardet R, Attum A, Barbie R, Yared I, Lansing A. Reoperation for prosthetic heart valve dysfunction. Tex Heart Inst J. 1990;17(2):106-111.
9. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol. 1991;17(3):646-650. doi: 10.1016/s0735-1097(10)80178-0.
10. Vitale N, Renzulli A, Cerasuolo F, et al. Prosthetic valve obstruction: thrombolysis versus operation. Ann Thorac Surg. 1994;57(2):365-370. doi: 10.1016/0003-4975(94)90998-9.
11. Renzulli A, De Luca L, Caruso A, Verde R, Galzerano D, Cotrufo M. Acute thrombosis of prosthetic valves: a multivariate analysis of the risk factors for a life threatening event. Eur J Cardiothorac Surg. 1992;6(8):412-420. doi: 10.1016/1010-7940(92)90065-6.
12. Antunes MJ. Fate of thrombectomized Björk-Shiley valves. J Thorac Cardiovasc Surg. 1986;92(5):965-966.
13. Edmunds LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg. 1987;44(4):430-445. doi: 10.1016/s0003-4975(10)63816-7.
14. Venugopal P, Kaul U, Iyer KS, et al. Fate of thrombectomized Björk-Shiley valves. A long-term cinefluoroscopic, echocardiographic, and hemodynamic evaluation. J Thorac Cardiovasc Surg. 1986;91(2):168-173.
15. Yoganathan AP, Corcoran WH, Harrison EC, Carl JR. The Björk-Shiley aortic prosthesis: flow characteristics, thrombus formation, and tissue overgrowth. Circulation. 1978;58(1):70-76. doi: 10.1161/01.cir.58.1.70.
16. Kontos GJ Jr, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Ann Thorac Surg. 1989;48(1):60-65. doi: 10.1016/0003-4975(89)90177-x.
17. Graver LM, Gelber PM, Tyras DH. The risks and benefits of thrombolytic therapy in acute aortic and mitral prosthetic valve dysfunction: report of a case and review of the literature. Ann Thorac Surg. 1988;46(1):85-88. doi: 10.1016/s0003-4975(10)65859-6.
18. Ledain LD, Ohayon JP, Colle JP, Lorient-Roudaut FM, Roudaut RP, Besse PM. Acute thrombotic obstruction with disc valve prostheses: diagnostic considerations and fibrinolytic treatment. J Am Coll Cardiol. 1986;7(4):743-751. doi: 10.1016/s0735-1097(86)80331-x.
19. Roudaut R, Labbe T, Lorient-Roudaut MF, et al. Mechanical cardiac valve thrombosis: Is fibrinolysis justified? Circulation. 1992;86(5 Suppl):II8-15.
20. Pradhan A, Bhandari M, Gupta V, et al. Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients with Prosthetic Valve Thrombosis: A Single-Center Experience. Cardiol Res. 2019;10(6):345-349. doi: 10.14740/cr924.
21. Jones JM, O'kane H, Gladstone DJ, et al. Repeat heart valve surgery: risk factors for operative mortality. J Thorac Cardiovasc Surg. 2001;122(5):913-918. doi: 10.1067/mtc.2001.116470.
22. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-142. doi: 10.1136/hrt.2005.071183.
23. Onorati F, Perrotti A, Reichart D, et al. Surgical factors and complications affecting hospital outcome in redo mitral surgery: insights from a multicentre experience. Eur J Cardiothorac Surg. 2016;49(5):e127-133. doi: 10.1093/ejcts/ezw048.
24. Russo M, Taramasso M, Guidotti A, et al. The evolution of surgical valves. Cardiovasc Med. 2017;20(12):285-292. doi: 10.4414/CVM.2017.00532
25. Kim YW, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Outcomes of Reoperative Valve Replacement in Patients with Prosthetic Valve Endocarditis: A 20-Year Experience. Korean J Thorac Cardiovasc Surg. 2018;51(1):15-21. doi: 10.5090/kjtcs.2018.51.1.15.
26. Kilic A, Acker MA, Gleason TG, et al. Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2019;107(3):754-759. doi: 10.1016/j.athoracsur.2018.08.083.
27. Tatsuishi W, Kumamaru H, Nakano K, Miyata H, Motomura N. Evaluation of postoperative outcomes of valve reoperation: a retrospective study. Eur J Cardiothorac Surg. 2021;59(4):869-877. doi: 10.1093/ejcts/ezaa384.

Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Kalp ve Damar Cerrahisi
Bölüm	Original Article
Yazarlar	Mehmet Nuri Karabulut 0000-0003-4418-6209 Rafet Günay 0000-0001-7498-2025 Mahmut Murat Demirtaş Bu kişi benim
Erken Görünüm Tarihi	14 Mayıs 2024
Yayımlanma Tarihi
Gönderilme Tarihi	31 Ocak 2024
Kabul Tarihi	30 Mart 2024
Yayımlandığı Sayı	Yıl 2024 EARLY ONLINE

Kaynak Göster

AMA	Karabulut MN, Günay R, Demirtaş MM. Obstructions of prosthetic heart valves: diagnosis and treatment considerations. Eur Res J. Published online 01 Mayıs 2024:1-10. doi:10.18621/eurj.1429266

Makale Dosyaları

Tam Metin

e-ISSN: 2149-3189

Facebook - Twitter - Linkedin - Instagram

The European Research Journal, hosted by Turkish JournalPark ACADEMIC, is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

2024