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Article: Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves cared for in a tertiary care center. What have we learned?

Sánchez-Medina, Fernando F / Valenzuela-Antelo, Olivia / Valenzuela-Molina, Lucía C / Arias-Martínez, Joel / López-Morales, Cruz M / Ornelas-Aguirre, José M

Gaceta medica de Mexico

2023 Volume 159, Issue 3, Page(s) 210–218

Abstract: ... sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical ... carefully chosen, and care priorities should include prevention and follow-up, especially in those patients ... Background: Heart valve replacement surgery with mechanical or biological prostheses entails ...

Title translation	Complicaciones tromboembólicas y hemorrágicas en pacientes portadores de prótesis valvulares del corazón en un centro de tercer nivel. ¿Qué hemos aprendido?
Abstract	Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.
MeSH term(s)	Humans ; Tertiary Care Centers ; Thromboembolism/epidemiology ; Thromboembolism/etiology ; Thromboembolism/prevention & control ; Heart Valve Prosthesis/adverse effects ; Anticoagulants/therapeutic use ; Hemorrhage/epidemiology ; Hemorrhage/etiology ; Heart Valves ; Heart Valve Prosthesis Implantation/adverse effects
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-07-26
Publishing country	Mexico
Document type	Journal Article
ZDB-ID	425456-9
ISSN	0016-3813
ISSN	0016-3813
DOI	10.24875/GMM.M23000772
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Article: Caring for patients with prosthetic heart valves.

Bettadapur, Monica S / Griffin, Brian P / Asher, Craig R

Cleveland Clinic journal of medicine

2001 Volume 69, Issue 1, Page(s) 75–87

Abstract: Patients with prosthetic heart valves require regular examinations and echocardiograms ... on the alert for several uncommon but potentially devastating complications: valve structural failure ...

Abstract	Patients with prosthetic heart valves require regular examinations and echocardiograms, antithrombotic therapy, and appropriate antibiotic prophylaxis against endocarditis. Physicians must also be on the alert for several uncommon but potentially devastating complications: valve structural failure, thrombosis, embolism, endocarditis, paravalvular leak, and hemolytic anemia.
MeSH term(s)	Heart Valve Diseases/complications ; Heart Valve Diseases/physiopathology ; Heart Valve Diseases/therapy ; Heart Valve Prosthesis ; Humans ; Patient Care
Language	English
Publishing date	2001-09-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639116-3
ISSN	0891-1150
ISSN	0891-1150
DOI	10.3949/ccjm.69.1.75
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Article: Care of the patient with a prosthetic heart valve.

Leonard, S R / Crawford, F A

Journal of the South Carolina Medical Association (1975)

1987 Volume 83, Issue 9, Page(s) 465–470

MeSH term(s)	Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/prevention & control ; Heart Valve Prosthesis/adverse effects ; Humans ; Prosthesis Failure ; Thromboembolism/drug therapy ; Thromboembolism/etiology
Language	English
Publishing date	1987-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	603510-3
ISSN	0038-3139
ISSN	0038-3139
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Article: NURSING CARE OF THE PATIENT WITH A PROSTHETIC HEART VALVE.

BRIGGS, L W / MORTENSEN, J D

The American journal of nursing

1963 Volume 63, Page(s) 66–70

MeSH term(s)	Artificial Organs ; Blood Pressure Determination ; Cardiac Surgical Procedures ; Convalescence ; Heart Valves ; Humans ; Positive-Pressure Respiration ; Postoperative Care ; Rheumatic Heart Disease ; Thoracic Surgery ; Tracheotomy
Language	English
Publishing date	1963-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	390780-6
ISSN	0002-936X
ISSN	0002-936X
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Article ; Online: Valvular Heart Disease in the Cardiac Intensive Care Unit.

Zern, Emily K / Frank, Rachel C / Yucel, Evin

Critical care clinics

2023 Volume 40, Issue 1, Page(s) 105–120

Abstract: Valvular heart disease pathologies are commonly encountered in the cardiac intensive care ... complications after transcatheter aortic, mitral, and tricuspid interventions. In addition, prosthetic valve ... dysfunction should always be excluded in a CICU patient presenting with an acute cardiopulmonary ...

Abstract	Valvular heart disease pathologies are commonly encountered in the cardiac intensive care unit (CICU). Clinical presentations may range from an acute pathology of the aortic or mitral valve necessitating emergency intervention to a more subtle decompensation of longstanding valvular disease. With growing numbers of transcatheter valvular interventions, CICU providers must recognize and manage common complications after transcatheter aortic, mitral, and tricuspid interventions. In addition, prosthetic valve dysfunction should always be excluded in a CICU patient presenting with an acute cardiopulmonary decompensation. Multidisciplinary valve teams can assist with challenging valvular pathologies to determine candidacy for potential interventions.
MeSH term(s)	Humans ; Heart Valve Prosthesis Implantation ; Heart Valve Diseases/therapy ; Heart Valve Diseases/surgery ; Mitral Valve/surgery ; Intensive Care Units
Language	English
Publishing date	2023-09-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1006423-0
ISSN	1557-8232 ; 0749-0704
ISSN (online)	1557-8232
ISSN	0749-0704
DOI	10.1016/j.ccc.2023.05.002
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Article: Etiology, clinical characteristics, and outcome of infective endocarditis: 10-year experience from a tertiary care center in Pakistan.

Ali, Sara Salim / Qureshi, Imran Ahmed / Ayaz, Ahmed / Arshad, Ainan / Farhad, Awais / Jamil, Bushra / Sohail, Muhammad Rizwan

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2022 Volume 92, Issue 4

Abstract: ... of the patients was 46.9±18.8 years. 95 (31%) had prosthetic valves in place. Staphylococcus aureus was isolated ... agent. Heart failure and stroke were the most common complications. The presence of prosthetic valves ... patients suffered from heart failure and 66 (22%) from a stroke during hospitalization. The mean hospital ...

Abstract	This study was conducted to assess the clinical characteristics, causative agents, complications, and outcomes of infective endocarditis (IE) among patients presenting to our tertiary care center over the last decade. This retrospective cohort study included all adult patients admitted to the Aga Khan University Hospital with the diagnosis of IE over a ten-year period from 2010 to 2020. Outcomes variables included complications during hospitalization, surgical intervention, mortality, and length of stay. We identified a total of 305 cases out of which 176 (58%) were males and 129 (42%) were females. The mean age of the patients was 46.9±18.8 years. 95 (31%) had prosthetic valves in place. Staphylococcus aureus was isolated in 54 (39%) patients followed by coagulase-negative Staphylococcus in 23 (17%). Echocardiography revealed vegetations and abscesses in 236 (77%) and 4 (1%) patients, respectively. The most common valvular complication was mitral valve regurgitation found in 26 (9%) patients, followed by tricuspid valve regurgitation in 13 (4%) patients and aortic valve regurgitation in 11 (3%) patients. Furthermore, 81 (27%) patients suffered from heart failure and 66 (22%) from a stroke during hospitalization. The mean hospital length of stay was 10.4 ± 10.6 days. 64 (21%) patients required surgical repair and the overall mortality rate was 25%. Prosthetic valve endocarditis (OR = 3.74, 95% CI = 2.15-6.50, p<0.001), chronic kidney disease (OR = 2.51, 95% CI = 1.15-5.47, p=0.036), previous stroke (OR = 2.42, 95% CI = 1.18-4.96, p=0.026), and ischemic heart disease (OR = 3.04, 95% CI = 1.50-6.16, p=0.003) were significantly associated with an increased risk of mortality. In conclusion, our study provided valuable data on the clinical characteristics and outcomes of patients with IE in a developing country. S. aureus was the most common causative agent. Heart failure and stroke were the most common complications. The presence of prosthetic valves, history of chronic kidney disease, ischemic heart disease and previous stroke were associated with a significantly increased risk of mortality. Surgical management was not associated with improved outcomes.
MeSH term(s)	Adult ; Male ; Female ; Humans ; Middle Aged ; Aged ; Endocarditis, Bacterial/diagnosis ; Staphylococcus aureus ; Tertiary Care Centers ; Retrospective Studies ; Pakistan/epidemiology ; Heart Valve Prosthesis/adverse effects ; Endocarditis/complications ; Endocarditis/epidemiology ; Endocarditis/diagnosis ; Heart Failure/etiology ; Stroke/complications
Language	English
Publishing date	2022-03-28
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2022.2212
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Article ; Online: Grayken lessons: the role of an interdisciplinary endocarditis working group in evaluating and optimizing care for a woman with opioid use disorder requiring a second tricuspid valve replacement.

Rozansky, Hallie / Awtry, Eric / Weinstein, Zoe M / Peterkin, Alyssa F

Addiction science & clinical practice

2023 Volume 18, Issue 1, Page(s) 9

Abstract: ... patients in the United States, and associated morbidity and mortality are rising.: Case presentation ... improvements in outcomes for patients with infective endocarditis and substance use disorders, and have ... of infective endocarditis requiring prosthetic tricuspid valve replacement, who developed worsening dyspnea ...

Abstract	Background: Injection drug use-related endocarditis is increasingly common among hospitalized patients in the United States, and associated morbidity and mortality are rising. Case presentation: Here we present the case of a 34-year-old woman with severe opioid use disorder and multiple episodes of infective endocarditis requiring prosthetic tricuspid valve replacement, who developed worsening dyspnea on exertion. Her echocardiogram demonstrated severe tricuspid regurgitation with a flail prosthetic valve leaflet, without concurrent endocarditis, necessitating a repeat valve replacement. Her care was overseen by our institution's Endocarditis Working Group, a multidisciplinary team that includes providers from addiction medicine, cardiology, infectious disease, cardiothoracic surgery, and neurocritical care. The team worked together to evaluate her, develop a treatment plan for her substance use disorder in tandem with her other medical conditions, and advocate for her candidacy for valve replacement. Conclusions: Multidisciplinary endocarditis teams such as these are important emerging innovations, which have demonstrated improvements in outcomes for patients with infective endocarditis and substance use disorders, and have the potential to reduce bias by promoting standard-of-care treatment.
MeSH term(s)	Female ; Humans ; United States ; Adult ; Tricuspid Valve/surgery ; Heart Valve Prosthesis Implantation ; Endocarditis/surgery ; Endocarditis, Bacterial/surgery ; Opioid-Related Disorders
Language	English
Publishing date	2023-02-07
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2492632-2
ISSN	1940-0640 ; 1940-0640
ISSN (online)	1940-0640
ISSN	1940-0640
DOI	10.1186/s13722-023-00360-7
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Article: Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management.

Wen, Songnan / Naqvi, Tasneem Z

Journal of clinical medicine

2023 Volume 12, Issue 20

Abstract: ... for early detection of VHD and its severity.: Methods: All consecutive patients with VHD who did not have ... to the POCUS results.: Results: A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total ... respectively, indicating excellent agreement.: Conclusions: POCUS can identify patients with significant VHD ...

Abstract	Background: Early diagnosis of significant valvular heart disease (VHD) enables appropriate implementation of the best therapeutic strategy and follow-up. Cardiac auscultation remains suboptimal in early detection of VHD. The aim of this study was to evaluate the utility of point-of-care ultrasound (POCUS) for early detection of VHD and its severity. Methods: All consecutive patients with VHD who did not have a standard echocardiogram prior to first outpatient cardiology consultation underwent history and physical examination followed by POCUS study by an experienced physician in a general cardiology clinic from June 2017 to August 2022 at our institution. Subsequent standard transthoracic echocardiography (sTTE) was performed as the gold standard. Comparison was performed between POCUS and sTTE for the presence and severity of VHD. sTTE was performed by registered cardiac sonographers and interpreted by another cardiologist blinded to the POCUS results. Results: A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total of 89 significant valvular abnormalities were diagnosed. There were 39 (43.8%) cases of regurgitant VHD, 16 (18.0%) of stenotic VHD and 34 (38.2%) had evaluation for prosthetic valve function. The sensitivity (90.9%; 82.4%; 83.3%; 100%) and specificity (100%; 96.7%; 100%; 100%) were high for detecting ≥ moderate aortic regurgitation (AR), mitral regurgitation (MR), aortic stenosis (AS) and prosthetic valvular abnormality, respectively. The weighted κ coefficient between POCUS and sTTE for the assessment of ≥ moderate MR, AR and AS was 0.81 (95% CI, 0.65-0.97), 0.94 (95% CI, 0.84-1.00) and 0.88 (95% CI, 0.76-1.0), respectively, indicating excellent agreement. Conclusions: POCUS can identify patients with significant VHD and may serve as a powerful screening tool for early detection of significant VHD in the outpatient clinical practice with downstream impact on clinical management of significant VHD.
Language	English
Publishing date	2023-10-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12206474
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Article: Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis.

Van Camp, Guy / Beles, Monika / Penicka, Martin / Schelfaut, Dan / Wouters, Stijn / De Raedt, Herbert / Wyffels, Eric / Spapen, Jerrold / Nasser, Riwa / Balogh, Zsuzsanna / Albano, Marzia / De Beenhouwer, Hans / Van Vaerenbergh, Kristien / Van Praet, Frank / Degrieck, Ivan / Stockman, Bernard / Casselman, Filip / Collet, Carlos

Journal of clinical medicine

2021 Volume 10, Issue 17

Abstract: ... disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients ... of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized ... patients with IE.: Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized ...

Abstract	Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75-80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.
Language	English
Publishing date	2021-08-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10173832
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Article ; Online: Early Trifecta valve failure: Report of a cluster of cases from a tertiary care referral center.

Kalra, Ankur / Rehman, Hasan / Ramchandani, Mahesh / Barker, Colin M / Lawrie, Gerald M / Reul, Ross M / Reardon, Michael J / Kleiman, Neal S

The Journal of thoracic and cardiovascular surgery

2017 Volume 154, Issue 4, Page(s) 1235–1240

Abstract: ... valves.: Methods: Trifecta valve failure occurred in 7 patients (8 valves) receiving 19-mm (n = 2), 21 ... Heart failure exacerbation was the most common presenting symptom.: Results: Five patients underwent surgical ... aortic valve replacement, 2 patients received valve-in-valve transcatheter aortic valve replacement, and 1 ...

Abstract	Background: The Trifecta valve (St Jude Medical, Inc, St Paul, Minn) was approved for commercial use by the US Food and Drug Administration in 2011. Several isolated cases have been reported since then, describing early structural valve deterioration. We report a case series of 8 Trifecta valve failures, describing patients' clinical substrate and management, and the pathologic characteristics of the explanted valves. Methods: Trifecta valve failure occurred in 7 patients (8 valves) receiving 19-mm (n = 2), 21-mm (n = 3), 23-mm (n = 1), and 25-mm (n = 2) valves. The mean duration of valve durability was 32 ± 21 months, and the most common lesion was prosthetic regurgitation. The mean Society of Thoracic Surgeons risk score for perioperative mortality at the time of reintervention was 9.75% ± 8.1%. Heart failure exacerbation was the most common presenting symptom. Results: Five patients underwent surgical aortic valve replacement, 2 patients received valve-in-valve transcatheter aortic valve replacement, and 1 patient died of cardiogenic shock before reintervention. The most common pathologic finding in the explanted valves was a tan-yellow fibrofatty circumferential pannus adherent to the inflow portion of the Trifecta valve. Conclusions: Our findings provide further insights into the pathologic mechanisms leading to early Trifecta valve failure. In addition to tear of the noncoronary cusp of the Trifecta prosthesis described as the most common mechanism in the literature for its failure, circumferential pannus formation composed of fibrofatty tissue in the inflow portion and leaflet calcification concentrated around the posts in the outflow portion are important mechanisms contributing toward early Trifecta valve failure.
MeSH term(s)	Aged ; Aortic Valve/surgery ; Bioprosthesis/adverse effects ; Equipment Failure Analysis ; Female ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/instrumentation ; Heart Valve Prosthesis Implantation/methods ; Hemodynamics ; Humans ; Male ; Middle Aged ; Mortality ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prosthesis Design ; Prosthesis Failure ; United States
Language	English
Publishing date	2017-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2017.05.044
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