Aspects of prosthetic valve endocarditis (original) (raw)
Blackwell Publishing eBooks, 2007
the number of heart valve replacement procedures has increased over the past four decades, with >200,000 done worldwide every year. Various valve substitutes are available, and are broadly divided into biological and mechanical prostheses. Choice is dictated by multiple factors, including longevity of the valve substitute as well as patient and surgeon preference. In general, mechanical valves are used in the younger age group and require lifelong anticoagulation. Biological valves are used in older age groups and have a limited lifespan compared to mechanical valves. the design of prosthetic heart valves continues to evolve, with improved haemodynamics, longevity and durability. Mortality and morbidity associated with heart valve surgery is low. Infrequent but major complications of valve replacement include haemorrhage, thromboembolism and infection.
Initial Experimental Experience with a “Replaceable” Cardiac Valve Prosthesis
Annals of Thoracic Surgery, 1988
An easily "replaceable" cardiac valve prosthesis has been designed. It consists of two parts: (1) a sewing ring incorporating a circlip and (2) a functioning valve (either mechanical or tissue). The circlip is encased in a sewing ring, which is sutured into the natural valve annulus, and grips the functional part of the prosthesis, thereby preventing dislodgment. A simple instrument has been designed to open the circlip a few millimeters to allow easy removal or insertion of the functional element. This sewing ring/circlip with the functional element of a Bjork-Shiley prosthesis was used in 10 baboons undergoing mitral valve replacement. Removal and replacement of the functional element was carried out at a second operation between 1 and 12 weeks later. There were no operative deaths. Baboons were electively killed one day to twelve months after the second operation. There were no complications related to the prosthesis; cardiac catheterization showed normal hemodynamics before and after the second operative procedure.
Risk Factors for Starr-Edwards Prosthetic Valve Dysfunction: New Insights into an Old Prosthesis
World Journal of Cardiovascular Diseases
Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5-64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.
Prosthetic aortic heart valves
2018
Background Aortic valve replacement (AVR) can be performed with different types of valve prostheses. There is no perfect aortic valve prosthesis, and the prosthetic choice for each patient requires careful consideration. This thesis evaluates mortality, morbidity, and prosthetic valve function after AVR with different aortic valve prostheses. Methods and Results Study I We studied all-cause mortality and postoperative outcomes in all 1219 patients who underwent AVR at Karolinska University Hospital between 2002 and 2010 and received either Perimount (n=864; Edwards Lifesciences, Irvine, CA) or Mosaic (n=355; Medtronic, Inc., Minneapolis, MN) bioprostheses. There was no difference in all-cause mortality (adjusted hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.65-1.11) or rate of aortic valve reoperation between the two groups. Severe prosthesis-patient mismatch (PPM) was more common in the Mosaic group than in the Perimount group (15% vs. 6%, p<0.001). Study II We studied hemodynamic function and postoperative outcomes in all 355 patients who underwent AVR at Karolinska University Hospital between 2002 and 2008 and received a Mosaic bioprosthesis. The mean pressure gradient was 21.2 mmHg and 22.5 mmHg during early and late echocardiography, respectively. Moderate or severe PPM was found in 299 (84%) patients, and 46 patients had moderate or severe aortic stenosis at late echocardiography, but neither was associated with increased mortality. Study III We studied all-cause mortality and postoperative outcomes in all 4545 patients aged 50-69 years who underwent primary, isolated AVR with biological (n=1832) or mechanical (n=2713) prostheses in Sweden between 1997 and 2013. The study population was obtained from the SWEDEHEART register. In a propensity score-matched analysis, patients with mechanical valve prostheses had better survival than patients with bioprostheses (HR 1.34, 95% CI 1.09-1.66, p=0.006). There was no difference in the rate of stroke, but patients with mechanical valves had a higher risk of major bleeding events and a lower risk of aortic valve reoperation than patients with bioprostheses. Study IV We studied all-cause mortality and postoperative outcomes in all 13 102 patients with moderately reduced (n=3266), or normal (n=9836) kidney function who underwent primary AVR in Sweden between 1997 and 2013. The study population was obtained from the SWEDEHEART register. Patients with normal kidney function had better survival than patients with moderately reduced kidney function (adjusted HR 1.28, 95% CI 1.18-1.38). Patients with moderately reduced kidney function had a slightly higher risk of major bleeding events and a lower risk of aortic valve reoperation than patients with normal kidney function. Study V We studied the incidence of prosthetic valve endocarditis (PVE) in all 26 580 patients who underwent AVR with biological (n=16 426) or mechanical (n=10 154) prostheses in Sweden between 1995 and 2012. The study population was obtained from the SWEDEHEART register. The incidence rate of PVE was 0.57% (95% CI 0.54-0.61) per person-year. The incidence of PVE was highest during the first year after surgery and remained stable thereafter for up to 18 years of follow-up. The risk of PVE was higher in patients with bioprostheses than in patients with mechanical valve prostheses (adjusted HR 1.54, 95% CI 1.29-1.83, p<0.001). Study VI We performed a systematic review and meta-analysis evaluating all-cause mortality after AVR in 49 190 patients who received bovine (n=32 235) versus porcine (n=16 955) bioprostheses. In total, seven articles met the inclusion criteria. The random-effects model was used to obtain pooled HR and 95% CI. The metaanalysis revealed no difference in survival between the groups (pooled HR 1.00, 95% CI 0.92-1.09). Conclusions [1] Both the Perimount and Mosaic bioprostheses are acceptable valve alternatives for AVR. [2] In patients aged 50-69 years, survival after AVR was better for those who received mechanical valve prostheses rather than bioprostheses. [3] After AVR, patients with moderately reduced kidney function have higher mortality than patients with normal kidney function. [4] After AVR, the yearly rate of PVE was 0.57%. Patients with bioprostheses had a higher risk of PVE than that of patients with mechanical valves. [5] Both bovine and porcine bioprostheses are acceptable valve choices for AVR. LIST OF SCIENTIFIC PAPERS I. Glaser N, Franco-Cereceda A, Sartipy U. Late survival after aortic valve replacement with the Perimount versus the Mosaic bioprosthesis.
African journal of Biological sciences, 2024
Background: Prosthetic heart valve replacement is the commonest choice in case of valvular failure or functional impairment. Although, they are considered to be ideal choices, they are vulnerable to dysfunction depending on various factors. Arising valvular dysfunctions are mostly related to stenosis or regurgitation. Methodology: This is a descriptive study including 30 participants out of which 17 are male and 13 are female. Subjects between 20 and 80 years of age with mitral valve replacement were included in the study with their consent. Subjects with other cardiac complications were excluded. The study was conducted for 12 months in the department of Echocardiography in a private institute for Cardiac sciences. Outcomes were assessed using ECG, ECHO, Catheterisation data, complications, type of valve used and symptoms associated with dysfunction. Results: Hypertension was seen in 50% subjects and mechanical valve was mostly used in subjects about 46.7%. observing the symptoms associated with dysfunction, syncopewas noted majorly in men about 93.3% and dyspnea was commonly seen in women about 63.3%. Dysfunction commonly occurred in 80% men on acitrom medication and 43.3% women on warfarin treatment. Conclusion: In conclusion we report that mechanical valves tend to cause valvular dysfunction alone or when supported by various other factors like use of drugs, comorbidities, social habits, and other cardiac disturbances. Although they are considered to be potentially a greater choice, they still tend to cause dysfunction which hinders the therapeutic progress. Further studies in larger sections need to be conducted to analyse the results more specifically and provide better therapeutic outcomes.
Practical Approach to the Evaluation of Prosthetic Mechanical and Tissue Replacement Heart Valves
Surgical Pathology Clinics, 2012
M echanical and bioprosthetic substitute heart valves have dramatically improved life expectancy and quality of life in patients with valvular heart disease. Complications of substitute heart valves are a relatively infrequent occurrence, and principally due to thrombosis, infection, or structural/mechanical failure. It is important to accurately identify and systematically evaluate prosthetic heart valves when encountered as surgical pathology specimens or in the autopsy setting.
Management of the Patient with a Prosthetic Heart Valve
The Annals of Thoracic Surgery, 1976
Approximately 20,000 heart valve pros-cardiac surgery makes it evident that new theses are inserted yearly in the United States. Even methods will have to be developed to cope with after successful heart operations, the patients who these conditions. Unfortunately, this aspect of receive them cannot be regarded as healthy individu-cardiac surgery has been neglected.
Prosthetic valve endocarditis: management strategies and prognosis
Netherlands Heart Journal, 2009
A ten-year analysis in a tertiary care centre in Tunisia Background. Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined. Objective. To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short-and midterm outcome in a tertiary care centre in a developing country (Tunisia). Methods. All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria. Results. A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09). Conclusion. PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach.
Up to Eight Years' Follow-up of 997 Patients Receiving the CarboMedics Prosthetic Heart Valve
2010
heart valve Up to eight years' follow-up of 997 patients receiving the CarboMedics prosthetic http://ats.ctsnetjournals.org/cgi/content/full/66/2/443 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. The aim of the study was to evaluate our clinical experience with the CarboMedics Heart Valve Prosthesis. Methods. Nine hundred ninety-seven consecutive patients underwent mechanical valve implantation (aortic, 771; mitral, 169; double, 52; tricuspid, 5) with this prosthesis from September 1987 through December 1993. The mean age was 62.3 ؎ 13.7 years (range, 0.4 to 84 years); 56.6% (564 patients) were men. Four hundred seventy patients (47.1%) underwent additional surgical procedures. Mean follow-up was 4.1 ؎ 2.2 years (range, 0 to 8.3 years) with a total of 4,040 patient-years. Results. Early mortality was 5.0% (50/997; aortic, 4.4%; mitral, 6.4%; double, 9.6%). Late mortality was 14.8% (140/947). Survival at 7 years was 75.9% ؎ 1.8% (aortic, 78.4% ؎ 2%; mitral, 70.7% ؎ 4.5%; double, 60.8% ؎ 7.4%).
Long-term performance of porcine heart valve bioprostheses
European Journal of Cardio-Thoracic Surgery, 1988
To assess the results after long-term implantation of porcine bioprosthetic heart valves, 320 patients with 381 valves were retrospectively reviewed. This group included all patients receiving one such xenograft in the mitral or aortic position (or both) in our institution between June 1974 and December 1976. The patients had a follow-up of 9-l 1.5 years. Actuarial patient survival rates (hospital mortality excluded) were 85%-90% at 6 years and 68%-79% at 11.5 years. Thromboembolic episodes did not show any significant clustering over the first weeks or months, in fact, they appeared at a constant rate. Actuarial rates of freedom from thromboembolism were > 90% for aortic patients at 11.5 years and > 80% for mitral and mitroaortic patients at 11.5 years. The linearized rate of anticoagulant-related haemorrhage for the whole group of patients was 0.4 events/100 patient years with a related mortality of 0.2 events/100 patient years. Prosthetic valve endocarditis and paravalvular leak appeared at linearized rates of 0.6 (0.1 of related mortality) and 0.4 (0.1 of related mortality) events/ 100 patient years. Primary tissue valve failure constituted the most prevalent complication (82 cases) in the long term but did not significantly worsen patient survival. Actuarial rates of freedom from primary tissue failure were 9 1% f 2% at 6, and 40% +_ 14% at 11.5 years for mitral valves, and 95% f 4% at 6 and 64% f 6% at 11.5 years for aortic valves. Patients older than 40 years at operation reached higher actuarial rates of freedom from tissue degeneration, particularly in the isolated aortic patients where the difference to the * This paper was supported in part by a grant from the Spanish Society of Cardiology younger population was significant after the 5th postoperative year (P< 0.05 in the 6th year, P < 0.003 in the following). Valves implanted in the mitral position displayed a tendency towards a greater failure rate than valves in the aortic position. This trend was more evident in patients older than 40 than in the younger population. The rates of freedom from any valve-related complication whether or not leading to death and/or reoperation were > 50% at 11.5 years for single aortic patients, and < 40% at 11.5 years for single mitral and mitroaortic patients.
Prosthetic Valve Endocarditis: Early Outcome following Medical or Surgical Treatment
The Journal of Tehran University Heart Center, 2008
Introduction Prosthetic valve endocarditis (PVE) remains a serious complication of cardiac valve replacement despite improvements in prostheses types, surgical techniques, and infection control measures. PVE is an endovascular, microbial infection occurring on parts of the valve prosthesis or on reconstructed native heart valves. 1 PVE occurs in 3% Background: Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. Methods: The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean±standard deviation, and the discrete variables were presented as percentages. Results: Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients).
Prosthetic heart valves: Catering for the few
Biomaterials, 2008
Prosthetic heart valves epitomize both the triumphant advance of cardiac surgery in its early days and its stagnation into a retrospective, exclusive first world discipline of late. Fifty-two years after the first diseased heart valve was replaced in a patient, prostheses largely represent the concepts of the 1960s with many of their design-inherent complications. While the sophisticated medical systems of the developed world may be able to cope with sub-optimal replacements, these valves are poorly suited to the developing world (where the overwhelming majority of potential valve recipients reside), due to differences in age profiles and socio-economic circumstances. Therefore, it is the latter group which suffered most from the sluggish pace of developments. While it previously took less than 7 years for mechanical heart valves to develop from the first commercially available ball-in-cage valve to the tilting pyrolytic-carbon disc valve, and another 10 years to arrive at the all-carbon bi-leaflet design, only small incremental improvements have been achieved since 1977. Similarly, bioprosthetic valves saw their last major break-through development in the late 1960s when formalin fixation was replaced by glutaraldehyde cross linking. Since then, poorly understood so-called 'anti-calcification' treatments were added and the homograft concept rediscovered under the catch-phrase 'stentless'. Still, tissue valves continue to degenerate fast in younger patients, making them unsuitable for developing countries. Yet, catheter-delivered prostheses almost exclusively use bioprosthetic tissue, thereby reducing one of the most promising developments for patients of the developing world into a fringe product for the few first world recipients. With tissue-engineered valves aiming at the narrow niche of congenital malformations and synthetic flexible leaflet valves being in their fifth decade of low-key development, heart valve prostheses seem to be destined to remain an unsatisfying and exclusive first world solution for a long time to come. r
St. Jude medical valve prosthesis: An analysis of long-term outcome and prognostic factors
The Journal of Thoracic and Cardiovascular Surgery, 1997
replacements). Follow-up was 96% complete (2967 patient-years; mean 9.5 years per patient). Actuarial event-free rates at 10 years and linearized rates (in parentheses) of late complications were as follows: embolism, 85.0%-2.3% (2.3% per patient-year); anticoagulant-related hemorrhage, 74.8%-2.7% (3.3% per patient-year); cerebrovascular accident, 81.8%-+ 2.5% (2.6% per patient-year); prosthesis thrombosis, 98.5%-0.7% (0.1% per patient-year); endocarditis, 97.2%-1.1% (0.4% per patient-year); prosthesis dysfunction, 97.1%-+ 1.0% (0.4% per patient-year); hemolytic anemia, 98.5%-+ 0.7% (0.1% per patient-year); reoperation, 97.4% + 1.0% (0.4% per patient-year); overall mortality, 63.3%-2.7% (4.2% per patientyear); and valve-related death (including sudden death), 84.7%-+ 2.2% (1.4% per patient-year). Independent preoperative risk factors were as follows: (1) for embolism, cardiac failure as indication for operation and history of prior systemic embolism; (2) for cerebrovascular accidents, the same two factors and age; (3) for endocarditis, diabetes, chronic alcoholism, and aortic valve replacement; (4) for overall mortality, age, ejection fraction (or cardiac index or cardiothoracic index), chronic alcoholism, and history of systemic embolism; and (5) for valve-related death, chronic alcoholism, degenerative cause of valve disease, and prosthetic diameter 23 mm or smaller. Ninety percent of survivors were in New York Heart Association functional class I or II at the end of follow-up. In conclusion, this study confirms the excellent durability of the St. Jude Medical valve and the remarkable functional benefit for the majority of the patients. However, prosthesis-related complications are still common, particularly for small-diameter prostheses. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.
Arquivos Brasileiros de Cardiologia
Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.