Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings.
Bioprosthetic valves are increasingly implanted, with generally consistent and durable results. Early bioprosthetic valve failure is uncommon, and most clinicians are unfamiliar with the spectrum of early structural complications involving bioprostheses. In this review, the authors organize causes of early bioprosthetic valve failure according to possible pathogenesis, demonstrate the correlation between echocardiographic and anatomic findings, and discuss potential treatments. First, they address early bioprosthetic valve stenosis secondary to thrombosis. Next, they discuss excessive pannus formation, a hitherto rarely described cause of early bioprosthetic valve failure. Finally, the authors address early structural valve deterioration mediated by calcification or primary tears. Illustrative examples with relevant echocardiographic and operative findings are provided.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Paul C
PC
Cremer
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
L Leonardo
LL
Rodriguez
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Brian P
BP
Griffin
Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Carmela D
CD
Tan
Department of Anatomic Pathology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
E Rene
ER
Rodriguez
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Douglas R
DR
Johnston
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Gosta B
GB
Pettersson
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: menonv@ccf.org.
Venu
V
Menon
D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001705:Bioprosthesis; D002114:Calcinosis / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D011475:Prosthesis Failure / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors
Bioprosthetic valve; Calcification; Pannus; Primary leaflet tear; Structural valve deterioration; Thrombus