Aspects of prosthetic valve endocarditis (original) (raw)
Related papers
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Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market.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.