title: Erythropoietin can obviate the need for repeated heart valve replacement in high-risk patients with severe mechanical hemolytic anemia: case reports and literature review.
abstract: OBJECTIVE
  Brisk hemolysis due to perivalvular leak is usually an indication for valve re-replacement. Repeated surgery after multiple previous valve operations is associated with high mortality, morbidity and failure rates. The present study evaluated the role of erythropoietin (EPO) administration in deferring or obviating the need for repeated surgery.
  
  
  METHODS
  Three patients (two men, one woman; age range 62-76 years) with two mechanical valves each and two to four previous heart valve operations, who suffered from severe mechanical hemolytic anemia, were given subcutaneous EPO for 15-17 months.
  
  
  RESULTS
  A marked reduction in red blood cell consumption was achieved with a weekly EPO dose of 18,000 U in two patients, both of whom also had mild or moderate kidney malfunction. A third patient with normal renal function and extreme hemolysis showed a transient, partial response to 30,000 U of EPO per week, and eventually needed a fifth operation.
  
  
  CONCLUSIONS
  EPO may defer or even obviate the need for repeated valve surgery in patients with severe hemolysis due to perivalvular leak, especially those with inadequate EPO response, such as those with renal malfunction.
authors.affiliation: The Dan Sheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Petah Tiqva, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Shapira
authors.forename: O
authors.initials: O
authors.lastname: Bairey
authors.forename: M
authors.initials: M
authors.lastname: Vatury
authors.forename: H
authors.initials: H
authors.lastname: Magen-Nativ
authors.forename: M
authors.initials: M
authors.lastname: Prokocimer
authors.forename: A
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000743:Anemia, Hemolytic / Q000209:etiology / Q000517:prevention & control*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D004921:Erythropoietin