TY - JOUR
T1 - Bioprosthetic Valve Thrombosis Versus Structural Failure
T2 - Clinical and Echocardiographic Predictors
AU - Egbe, Alexander C.
AU - Pislaru, Sorin V.
AU - Pellikka, Patricia A.
AU - Poterucha, Joseph T.
AU - Schaff, Hartzell V.
AU - Maleszewski, Joseph J.
AU - Connolly, Heidi M.
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015
Y1 - 2015
N2 - Background Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to Vitamin K antagonists, emphasizing the need for reliable diagnosis. Objectives This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT. Methods Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic. Results Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p < 0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p < 0.001). Conclusions BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.
AB - Background Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Recent data suggest that BPVT responds to Vitamin K antagonists, emphasizing the need for reliable diagnosis. Objectives This study sought to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT. Methods Cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched 1:2 for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. We formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic. Results Among 397 consecutive cases of explanted bioprostheses, there were 46 cases of BPVT (11.6%; aortic 29, mitral 9, tricuspid 7, pulmonary 1), mean age was 63 years, and 68% were male. Thirty (65%) cases occurred >12 months post-implantation; median bioprosthetic valve longevity was 24 months (cases) versus 108 months (controls) (p < 0.001). Independent predictors of BPVT were >50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR]: 12.7), paroxysmal atrial fibrillation (OR: 5.19), subtherapeutic international normalized ratio (OR: 7.37), increased cusp thickness (OR: 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value (p < 0.001). Conclusions BPVT is not uncommon and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT.
KW - Doppler gradient
KW - Vitamin K antagonist
KW - atrial fibrillation
KW - cusp
KW - valvular heart disease
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U2 - 10.1016/j.jacc.2015.09.022
DO - 10.1016/j.jacc.2015.09.022
M3 - Article
C2 - 26610876
AN - SCOPUS:84951116358
SN - 0735-1097
VL - 66
SP - 2285
EP - 2294
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -