Surgery for prosthetic valve obstruction. A single center study of 136 patients.
OBJECTIVE
Prosthetic heart valve obstruction (PHVO) is a potentially fatal complication of heart valve replacement with mechanical substitute mainly due to thrombosis. The purpose of this report is to present a single-center experience of 136 consecutive patients operated on between 1978 and 2001.


METHODS
The diagnosis of PHVO was mainly assessed by fluoroscopy and/or echocardiography. Thrombosed valves were bileaflet (82), tilting disc (47) and ball cage (7) valves; of these, 90 were in mitral, 38 in aortic, six in aortic and mitral position, and two in tricuspid position. The mean interval between the first implantation and valve thrombosis was 7.4+/-6.6 years (range 1 day to 28 years); in 37 patients preoperative medical therapy (fibrinolysis in 21, and heparin alone in 16) was unsuccessful.


RESULTS
Operative procedures included valve re-replacement in 104 cases and declotting-pannus excision in 32 cases. Early hospital mortality was 10.3% (14 patients), all in NYHA class III or IV, and one patient suffered a perioperative cerebral embolic event. Surgery was then successful in 121 of 136 patients (89%), but during a 3.15-year follow-up, prosthetic heart valve thrombosis recurred in ten out of 122 survivors (8.1%).


CONCLUSIONS
From this experience, it can be concluded that for most PHVO, early operation is currently effective and safe, especially in patients in stable hemodynamic condition preoperatively.
Roudaut
Raymond
R
Department of Cardiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France. raymond.roudaut@pu.u-bordeaux2.fr
Roques
Xavier
X
Lafitte
Stéphane
S
Choukroun
Emmanuel
E
Laborde
Nadine
N
Madona
Francesco
F
Deville
Claude
C
Baudet
Eugène
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome