Subclinical Valve Thrombosis in Sutureless Bioprosthetic Valves.
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ABSTRACT:
SUBMITTER: Yanagawa B
PROVIDER: S-EPMC5586480 | biostudies-literature | 2017 Aug
REPOSITORIES: biostudies-literature
Publications
Subclinical Valve Thrombosis in Sutureless Bioprosthetic Valves.
Yanagawa Bobby B Verma Subodh S Mazer C David CD
Journal of the American Heart Association 20170821 8
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Project description:Underexpansion of transcatheter heart valves and the surgically implanted Perceval sutureless aortic valve bioprosthesis has been suggested as an underlying mechanism for hypo-attenuated leaflet thickening (HALT). This was a single-center prospective observational study that included 47 patients who underwent surgical aortic valve replacement with the Perceval sutureless bioprosthesis (LivaNova, London, United Kingdom) from 2012 to 2016 and were studied by four-dimensional cardiac computed tomography (CT). The association between overall and regional expansion and the prevalence of HALT was analyzed. In total 46 patients were included in the analysis. HALT was found in 39.1% of patients and the mean overall prosthesis expansion was 75.5?±?5.2% (range 64.6-84.8%). Overall expansion did not differ between patients with HALT compared with patients without HALT (mean overall expansion 74.0?±?5.2% vs. 76.5?±?5.0%, P?=?0.11). The prevalence of HALT was lower in patients with overall expansion?>?80% compared to patients with expansion?<?80% expansion though not significantly (20% vs. 44.4%, P?=?0.16). None or trivial regional underexpansion was found in 94.7% of coronary cusps. There was no significant association between regional underexpansion and the prevalence of HALT (mean coronary cusp angle 120?±?8° vs. 119?±?10°, P?=?0.53). The prevalence of HALT and overall underexpansion was high in the Perceval sutureless bioprosthetic valve. Overall underexpansion was not associated with HALT. Whether severe overall underexpansion increases the risk for HALT requires further study. Regional underexpansion was uncommon in the Perceval sutureless bioprosthetic valve and not associated with HALT.Clinical trial registration Unique identifier: NCT03753126 (http://www.clinicaltrials.gov).
| S-EPMC7198640 | biostudies-literature
Project description: Not available
| S-EPMC8940997 | biostudies-literature
Project description:Sutureless bioprosthetic valves such as the Sorin Perceval S valve (SPV) have been used in patients with aortic stenosis that require surgical aortic valve replacement (SAVR). These prostheses have been marketed on the basis of their rapid implantation techniques with avoidance of sutures and reduced aortic cross-clamp times. We report a case of an early failure of a SPV nearly 4 years after implantation in a 58-year-old woman who was low-risk. While the patient's symptoms initially improved with SAVR with a sutureless bioprosthetic valve, they progressively worsened as the valve degraded, and the leaflets became increasingly calcified and stenotic ultimately, requiring reoperative SAVR with a St. Jude mechanical valve. This case raises the issue of the lack of much-needed data describing the long-term durability and hemodynamic performance of these valves, particularly in a low-risk patient with excellent functional status. We hope to shed further insight into the lack of long-term studies on patients with SPV to assess their longevity and long-term effectiveness, as well as elucidation of possible prevention and monitoring of these potential complications. The use of newer generation prostheses, although attractive for their ease of implantation, potentially carries higher long-term risk due to shorter durability leading to reintervention to address valve deterioration. This is especially true in low-risk patients who are young and active. Cardiology and cardiothoracic surgery societies need to develop a universal registry with follow-up of all valves in order to track and study the durability of these valves, and to evaluate for incidence of known and potential complications.
| S-EPMC7092772 | biostudies-literature
Project description:During the last decade, transcatheter aortic valve replacement (TAVR) has rapidly expanded as an alternative to surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic valve stenosis (AS) and increased surgical risk. In TAVR, a bioprosthetic valve is positioned within the stenotic native aortic valve. Although favorable short- and medium-term outcomes have been reported, thrombosis of the transcatheter heart valve (THV) has occurred, with two different entities being described: clinical valve thrombosis and subclinical leaflet thrombosis. In clinical valve thrombosis, an increase in transvalvular gradient appears as a result of obstructive thrombus formation, which eventually leads to symptoms of heart failure. Subclinical leaflet thrombosis is an incidental finding, characterized by a thin layer of thrombus covering the aortic site of the leaflet-called hypo-attenuating leaflet thickening (HALT)-as described on and defined by 4-dimensional computed tomography (4DCT) imaging. This phenomenon may affect motion of the leaflets and is then classified as hypo-attenuation affecting motion (HAM). Even in the case of HAM, the transvalvular pressure gradient remains within the normal range. Clinical valve thrombosis requires treatment, whereas the clinical impact and need for intervention in subclinical leaflet thrombosis is uncertain. Anticoagulant therapy protects against and resolves both clinical valve thrombosis and subclinical leaflet thrombosis, but studies exploring different antithrombotic strategies after TAVR are ongoing. This review summarizes currently available literature within the field of THV thrombosis and provides recommendations for a patient-tailored approach in TAVR patients, although guidelines are still lacking.
| S-EPMC8985807 | biostudies-literature
Project description: Not available
| S-EPMC10443654 | biostudies-literature
Project description:The prevalence of hypo-attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) is unknown in surgically implanted bioprostheses because systematic investigation of HALT and/or RLM is limited to a few catheter-based valves. The aim of this study was to investigate the prevalence of HALT and RLM by cardiac computed tomography in patients who underwent surgical aortic valve replacement and received a Perceval sutureless aortic valve bioprosthesis. This was a single-center prospective observational study that included 47 patients (83.5% of the total number of implantations) who underwent surgical aortic valve replacement with implantation of the Perceval sutureless bioprosthesis (LivaNova PLC, London, UK) at Karolinska University Hospital in Stockholm, Sweden from 2012 to 2016 and were studied by cardiac computed tomography. Cardiac computed tomography was performed at a median of 491 days (range 36-1247 days) postoperatively. HALT was found in 18 (38%) patients and RLM in 13 (28%) patients. All patients with RLM had HALT. Among patients with HALT, 5 out of 18 patients (28%) were treated with anticoagulation (warfarin or any novel oral anticoagulant) at the time of cardiac computed tomography. Among patients with RLM, 3 out of 13 patients (23%) were treated with anticoagulation. HALT and RLM were prevalent in the surgically implanted Perceval sutureless aortic valve bioprosthesis. Both HALT and RLM were found in patients with ongoing anticoagulation treatment. Whether these findings are associated with adverse events needs further study. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02671474.
| S-EPMC5586405 | biostudies-literature
Project description:Bioprosthetic valve thrombosis (BPVT) is a rare but potentially life-threatening complication. Human menopausal gonadotropin (hMG) is commonly used for ovulation induction and has been associated with arterial and venous thrombosis. We reported a case of BPVT related to in vitro fertilization in a 39-year-old female, who underwent redo mitral valve replacement. To the best of our knowledge, this is the first case of hMG-induced BPVT in a young female patient.
| S-EPMC6057167 | biostudies-literature
Project description:Bioprosthetic valve thrombosis (BPVT) is more common than previously thought and likely underreported. BPVT can be accurately diagnosed with cardiac imaging and treated successfully with anticoagulation, thus preventing reoperation. We hereby report a case of recurrent BPVT in the mitral position successfully treated with anticoagulation along with review of literature.
| S-EPMC8749813 | biostudies-literature
Project description:A 48-year-old woman presented with heart failure and bioprosthetic pulmonary valve regurgitation 2 years after pulmonary valve replacement. Intracardiac echocardiography demonstrated uniform thickening of a single prosthetic valve leaflet suggesting leaflet thrombosis rather than bioprosthetic valve degeneration. After 3 months of anticoagulation, valve regurgitation and symptoms improved. (Level of Difficulty: Intermediate.).
| S-EPMC8302786 | biostudies-literature
Project description:IntroductionTranscatheter aortic valve replacement (TAVR) has become a widely used, comparably efficient and safe alternative to surgical aortic valve replacement (SAVR). Its utilization continues to grow, especially among younger patients. Despite improvements in durability, degeneration and subsequent re-interventions of failed prosthetic valves are still common. Even though valve-in-valve procedures have become more frequent, little is known about the trends over time or about clinical and echocardiographic long-term outcomes.Materials and methodsPatients who underwent a valve-in-valve procedure between December 2011 and December 2022 in a large tertiary university hospital were analyzed. Primary outcomes were defined as procedural and device successes as well as event-free survival. Secondary analyses between subsets of patients divided by index valve and date of procedure were performed.ResultsAmong 1407 procedures, 58 (4%) were valve-in-valve interventions, with an increased frequency observed over time. Overall, technical success was achieved in 88% and device success in 85% of patients. Complications were predominantly minor, with similar success rates among TAVR-in-SAVR (TiSAVR) and TAVR-in-TAVR (TiTAVR). Notably, there were significant and lasting improvements in mean echocardiographic gradients at 1 year. Event-free survival was 76% at one month and 69% at one year.ConclusionsOver the last decade, a rising trend of valve-in-valve procedures was observed. Despite an increase in procedures, complications show a contrasting decline with improved technical and device success over time. TiSAVR and TiTAVR showed comparable rates of procedural and device success as well as similar outcomes, highlighting the utility of valve-in-valve procedures in an aging population.
| S-EPMC10531770 | biostudies-literature