scholarly journals Antithrombotic Treatment After Surgical and Transcatheter Heart Valve Repair and Replacement

2021 ◽  
Vol 8 ◽  
Author(s):  
Andreas Verstraete ◽  
Marie Christine Herregods ◽  
Peter Verbrugghe ◽  
Marie Lamberigts ◽  
Thomas Vanassche ◽  
...  
Keyword(s):  
Heart Valve ◽  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Patient Treatment ◽  
Prosthetic Heart Valves ◽  
Valve Repair ◽  
University Hospitals ◽  
Transcatheter Heart Valve ◽  
The University ◽  
Current Guidelines

New antithrombotic drugs have been developed, new valve types have been designed and minimally invasive transcatheter techniques have emerged, making the choice of antithrombotic therapy after surgical or transcatheter heart valve repair and replacement increasingly complex. Moreover, due to a lack of large randomized controlled trials many recommendations for antithrombotic therapy are based on expert opinion, reflected by divergent recommendations in current guidelines. Therefore, decision-making in clinical practice regarding antithrombotic therapy for prosthetic heart valves is difficult, potentially resulting in sub-optimal patient treatment. This article compares the 2017 ESC/EACTS and 2020 ACC/AHA guidelines on the management of valvular heart disease and summarizes the available evidence. Finally, we established a convenient consensus on antithrombotic therapy after valve interventions based on over 800 annual cases of surgical and transcatheter heart valve repair and replacement and a multidisciplinary team discussion between the department of cardiovascular diseases and cardiac surgery of the University Hospitals Leuven, Belgium.

scholarly journals Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

2022 ◽  
Vol 17 (6) ◽  
pp. 831-836
Author(s):  
A. S. Gerasimenko ◽  
O. V. Shatalova ◽  
V. S. Gorbatenko ◽  
V. I. Petrov
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Prosthetic Heart Valves ◽  
Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

scholarly journals Hemodynamic Performance of Dysfunctional Prosthetic Heart Valve with the Concomitant Presence of Subaortic Stenosis: In Silico Study

2020 ◽  
Vol 7 (3) ◽  
pp. 90
Author(s):  
Othman Smadi ◽  
Anas Abdelkarim ◽  
Samer Awad ◽  
Thakir D. Almomani
Keyword(s):  
Early Detection ◽  
Heart Valve ◽  
Heart Valves ◽  
Cfd Simulation ◽  
Treatment Plan ◽  
Mechanical Heart Valve ◽  
Prosthetic Heart Valve ◽  
Subaortic Stenosis ◽  
Prosthetic Heart Valves ◽  
The Impact

The prosthetic heart valve is vulnerable to dysfunction after surgery, thus a frequent assessment is required. Doppler electrocardiography and its quantitative parameters are commonly used to assess the performance of the prosthetic heart valves and provide detailed information on the interaction between the heart chambers and related prosthetic valves, allowing early detection of complications. However, in the case of the presence of subaortic stenosis, the accuracy of Doppler has not been fully investigated in previous studies and guidelines. Therefore, it is important to evaluate the accuracy of the parameters in such cases to get early detection, and a proper treatment plan for the patient, at the right time. In the current study, a CFD simulation was performed for the blood flow through a Bileaflet Mechanical Heart Valve (BMHV) with concomitant obstruction in the Left Ventricle Outflow Tract (LVOT). The current study explores the impact of the presence of the subaortic on flow patterns. It also investigates the accuracy of (BMHV) evaluation using Doppler parameters, as proposed in the American Society of Echocardiography (ASE) guidelines.

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

CHEST Journal ◽  
1998 ◽  
Vol 114 (5) ◽  
pp. 602S-610S ◽  
Author(s):  
Paul D. Stein ◽  
Joseph S. Alpert ◽  
James E. Dalen ◽  
Dieter Horstkotte ◽  
Alexander G.G. Turpie
Keyword(s):  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Prosthetic Heart Valves

Modeling of Tissue Fatigue Damage in Bio-Prosthetic Heart Valve

2011 ◽  
Author(s):  
Caitlin Martin ◽  
Wei Sun
Keyword(s):  
Fatigue Damage ◽  
Heart Valve ◽  
Anticoagulant Therapy ◽  
Heart Valves ◽  
Prosthetic Heart Valve ◽  
Bovine Pericardium ◽  
Prosthetic Heart Valves ◽  
Mechanical Valves ◽  
In Vivo Degradation

Bio-prosthetic heart valves (BHVs) with leaflets made of glutaraldehyde-treated bovine pericardium (GLBP), have been used extensively to replace diseased heart valves. BHVs display superior hemodynamics to mechanical valves and eliminate the need for anticoagulant therapy; however, they exhibit poor durability resulting from in vivo degradation and fatigue damage of the leaflets.

TRIZ Based Tool Management Applied in Mechanical Heart Valve Engineering Systems

2012 ◽  
Vol 569 ◽  
pp. 521-524
Author(s):  
Feng Zhou ◽  
Yuan Yuan Cui ◽  
Liang Liang Wu ◽  
Yin Chen ◽  
Jie Yang ◽  
...  
Keyword(s):  
Heart Valve ◽  
Heart Valves ◽  
Production Systems ◽  
Mechanical Heart Valve ◽  
Complex Case ◽  
Evolutionary Development ◽  
Prosthetic Heart Valves ◽  
Engineering Systems ◽  
Device Structure

Artificial mechanical heart valve (MHV) replacement is the common cardiovascular surgical procedure, yet its effect is far from satisfaction. Most important reasons lie in the model design and choice of the materials in the fabrication of the prosthetic heart valves. Based on systematic design methodology of TRIZ theory (Russian acronym for Theory of Solving Inventive Problem), the device structure is analyzed by comparing the past successful designs generated during the evolution of MHV. This paper represents a modeling technique integrating the well-established TRIZ with the conflict and contradiction modeling, substance-field and product functional analysis tools and provides some important trends in evolutionary development of production systems in MHV design. By analyzing the structural behavior and material performance, a complex case study from the research of different structural patterns and characteristics of current tri-leaflet modeling shows the validity of TRIZ theory to guide MHV design.

Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

CHEST Journal ◽  
2001 ◽  
Vol 119 (1) ◽  
pp. 220S-227S ◽  
Author(s):  
Paul D. Stein ◽  
Joseph S. Alpert ◽  
Henry I. Bussey ◽  
James E. Dalen ◽  
Alexander G.G. Turpie
Keyword(s):  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Prosthetic Heart Valves

scholarly journals Prophylaxis of thrombotic complications in a pregnant patients with prosthetic heart valves

2012 ◽  
Vol 61 (5) ◽  
pp. 10-24
Author(s):  
Aleksandr Davidovich Makatsariya ◽  
Viktoriya Omarovna Bitsadze ◽  
Dzhamilya Khizriyevna Khizroyeva ◽  
Vyacheslav Borisovich Nemirovskiy ◽  
Svetlana Vladimirovna Akinshina
Keyword(s):  
Heart Valve ◽  
Heart Valves ◽  
Anticoagulation Therapy ◽  
Mechanical Heart Valve ◽  
Prosthetic Heart Valves ◽  
Dose Selection ◽  
Heart Valve Prostheses ◽  
Adequate Dose ◽  
Thrombotic Complications ◽  
Valve Prostheses

In patients with prosthetic heart valves pregnancy and labor are associated with high risk. There are no established anticoagulation guidelines in pregnant women with mechanical heart valve prostheses. More often physiological hypercoagulable state during pregnancy can reveal acquired and/or inherited hemostasis abnormalities which were asymptotic before pregnancy. The presence in the history of patients the foetal loss syndrome, severe obstetric complications (severe preeclampsia, abruptio placenta, antenatal fetal death, feto-placental insufficiency), thrombosis events is an indication for the screening for genetic thrombophilia and antiphospholipid syndrome. The diagnosis of thrombophilia in patients with mechanical heart valve prostheses can explain the inefficiency of anticoagulation therapy, warfarin resistance, «floating» hemostasis markers and difficulties in adequate dose selection

scholarly journals P1521 Prosthetic heart valve-related stroke: a single center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Almaghraby ◽  
M Abdelnabi ◽  
Y Saleh ◽  
O Abdelkarim ◽  
O Ozden Tok ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Heart Valve ◽  
Heart Valves ◽  
Hemorrhagic Stroke ◽  
Mechanical Valve ◽  
Prosthetic Heart Valves ◽  
Single Center ◽  
Single Center Experience ◽  
Valve Prostheses

Abstract OnBehalf YIG-CVR Introduction Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves. Aim of the work To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves. Methods and Patients A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017. All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected. Results 214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%). Conclusion In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes. Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage) Abstract P1521 Figure. Valve sites

Research Contribution of Prosthetic Valve Manufacturers Interfacing Academic-Industry Research Efforts

1999 ◽  
Author(s):  
Xiao Gong ◽  
Yi-Ren Woo ◽  
Ajit P. Yoganathan ◽  
Andreas Anayiotos
Keyword(s):  
Heart Valve ◽  
Heart Valves ◽  
Clinical Performance ◽  
Thrombus Formation ◽  
Academic Research ◽  
Prosthetic Heart Valve ◽  
Structural Safety ◽  
Prosthetic Heart Valves ◽  
Implantable Medical Device ◽  
Valve Design

Abstract Prosthetic heart valve is one of the most successful implantable medical devices. However, introducing better performing and longer lasting prosthetic mechanical heart valves (MHV) into clinical use has been slow because predicting the long term performance of a new valve design is difficult. Although significant progresses in many scientific fronts relevant to prosthetic heart valve development have been achieved, we still have an imperfect understanding of host responses to an implantable medical device and incomplete knowledge in associating hemodynamic characteristics of a valve design to clinical performance. Valve designers, frequently need to over design the valve components to ensure structural safety and thus, sacrifice the opportunity to optimize performance. Complications such as infection, thrombus formation, thromboembolic incidents, and hemorrhage associated to the use of prosthetic valves are still reported and valve designers are working hard to eliminate them. Further advancing scientific knowledge in designing and evaluating prosthetic heart valves is of great interest to many Valve designers and manufacturers. Interfacing Industry and Academic research efforts has been thwarted due to predominantly proprietary issues. Considering the benefits of a better performing MHV to the patients, this industry session will bring researchers from various MHV companies and academic institutions to discuss how to share the results of scientific studies more effectively. This will help accelerate new MHV development without compromising the confidentiality of key valve design information. The issue of standardized MHV testing will also be addressed.

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