Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis. The Role of Echocardiography

Alexander Egbe, Sorin V. Pislaru, Mahmoud A. Ali, Arooj R. Khan, Amber N. Boler, Hartzell V Schaff, Emmanuel Akintoye, Heidi M. Connolly, Vuyisile T Nkomo, Patricia Pellikka

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD). Background: Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation. Methods: The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50% increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation. Results: There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65%). The prosthesis positions were aortic 56%; mitral 26%; tricuspid 15%; and pulmonary 3%. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88%) versus 20 of 188 (11%) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81% of BPVT and 90% of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001). Conclusions: Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - 2017

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Echocardiography
Thrombosis
Prostheses and Implants
Institutional Practice
Acute Disease
Case-Control Studies
Guidelines
Lung

Keywords

  • Bioprosthetic valve thrombosis
  • Echocardiography
  • Prosthesis dysfunction
  • Prosthesis hemodynamics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis. The Role of Echocardiography. / Egbe, Alexander; Pislaru, Sorin V.; Ali, Mahmoud A.; Khan, Arooj R.; Boler, Amber N.; Schaff, Hartzell V; Akintoye, Emmanuel; Connolly, Heidi M.; Nkomo, Vuyisile T; Pellikka, Patricia.

In: JACC: Cardiovascular Imaging, 2017.

Research output: Contribution to journalArticle

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title = "Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis. The Role of Echocardiography",
abstract = "Objectives: The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD). Background: Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation. Methods: The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50{\%} increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation. Results: There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65{\%}). The prosthesis positions were aortic 56{\%}; mitral 26{\%}; tricuspid 15{\%}; and pulmonary 3{\%}. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88{\%}) versus 20 of 188 (11{\%}) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81{\%} of BPVT and 90{\%} of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001). Conclusions: Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.",
keywords = "Bioprosthetic valve thrombosis, Echocardiography, Prosthesis dysfunction, Prosthesis hemodynamics",
author = "Alexander Egbe and Pislaru, {Sorin V.} and Ali, {Mahmoud A.} and Khan, {Arooj R.} and Boler, {Amber N.} and Schaff, {Hartzell V} and Emmanuel Akintoye and Connolly, {Heidi M.} and Nkomo, {Vuyisile T} and Patricia Pellikka",
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T1 - Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis. The Role of Echocardiography

AU - Egbe, Alexander

AU - Pislaru, Sorin V.

AU - Ali, Mahmoud A.

AU - Khan, Arooj R.

AU - Boler, Amber N.

AU - Schaff, Hartzell V

AU - Akintoye, Emmanuel

AU - Connolly, Heidi M.

AU - Nkomo, Vuyisile T

AU - Pellikka, Patricia

PY - 2017

Y1 - 2017

N2 - Objectives: The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD). Background: Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation. Methods: The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50% increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation. Results: There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65%). The prosthesis positions were aortic 56%; mitral 26%; tricuspid 15%; and pulmonary 3%. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88%) versus 20 of 188 (11%) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81% of BPVT and 90% of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001). Conclusions: Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.

AB - Objectives: The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD). Background: Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation. Methods: The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50% increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation. Results: There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65%). The prosthesis positions were aortic 56%; mitral 26%; tricuspid 15%; and pulmonary 3%. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88%) versus 20 of 188 (11%) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81% of BPVT and 90% of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001). Conclusions: Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.

KW - Bioprosthetic valve thrombosis

KW - Echocardiography

KW - Prosthesis dysfunction

KW - Prosthesis hemodynamics

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