Reason Analysis and Prevention of Late Bioprosthetic Heart Valve Thrombosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGBen ^1,2 ^# , WANGYang ² ^# , LIUXiao-hong ² , ZHANGXi-wu ² , GONGDe-jun ² , TANGHao ² ,  XUZhi-yun ²

1. Centre of Cardiovascular Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P. R. China;
2. Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P. R. China;

Corresponding author：

XUZhi-yun, Email: xuzhiyun@live.cn

Keywords：

Prosthetic heart valve; Bioprosthetic valve; Thrombosis; Prevention

DOI：

10.7507/1007-4848.20150081

Video：

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Objective To analyze the reason and prevention of late bioprosthetic heart valve thrombosis (LBVT). Methods Bioprosthetic heart valves were implanted in 580 patients between January 2001 and July 2013 in Changhai Hospital, and only found one case of LBVT (0.2%). Reoperation was performed for a 67-year-old male patient 3 years after bioprosthetic aortic valve replacement due to severe aortic valve stenosis. Retrospectively analyzed the clinical data and reviewed the literature between January 1989 and December 2013 in Pubmed. Results No risk factor for thrombosis was revealed in this patient. Pathology revealed valve thrombosis and collagen and elastic fibers fragmentation and disruption in valve leaflets. In literature review, 20 articles and 47 cases were brought in. The morbidity of LBVT was 0.2%-1.0%. At least 18 patients had high risk factors, and 15 of the 18 patients discontinued anticoagulation after 3 months. However, at least 10 patients had no high risk factors. Forty-four of the 47 patients received stented porcine valve replacement, only one patient received stented bovine pericardial valve replacement. Conclusions LBVT is a rare but serious complication after bioprosthetic valve replacement, the causes of which include the feature of the patients and the bioprosthetic valves. Bovine pericardial valves could be superior to porcine valves in preventing LBVT. Postoperative long-time aspirin therapy is recommended for patients without high risk factors. Patients with any high risk factors should prolong anticoagulation.

Citation： ZHANGBen, WANGYang, LIUXiao-hong, ZHANGXi-wu, GONGDe-jun, TANGHao, XUZhi-yun. Reason Analysis and Prevention of Late Bioprosthetic Heart Valve Thrombosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 292-297. doi: 10.7507/1007-4848.20150081 Copy

1.	Zilla P, Brink J, Human P, et al.Prosthetic heart valves:catering for the few.Biomaterials, 2008, 29(4):385-406.
2.	Babin-Ebell J, Schmidt W, Eigel P, et al.Aortic bioprosthesis without early anticoagulation——risk of thromboembolism.Thorac Cardiovasc Surg, 1995, 43(4):212-214.
3.	Guyatt GH, Akl EA, Crowther M, et al.Executive summary:antithro-mbotic therapy and prevention of thrombosis, 9th ed:American college of chest physicians evidence-based clinical practice guide-lines.Chest, 2012, 141(2 Suppl):7S-47S.
4.	Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al.Prognosis after aortic valve replacement with a bioprosthesis:predictions based on meta-analysis and microsimulation.Circulation, 2001, 103(11):1535-1541.
5.	Moujir F, Martin-Duran R, Vazquez De Prada JA, et al.Dysfunction in a Hancock mitral valve bioprosthesis caused by thrombosis and resolved with heparin.Rev Esp Cardiol, 1989, 42(3):219-221.
6.	Tabone X, Berdah J, Le Feuvre C, et al.Late occlusive thrombosis of mitral prosthesis with sinus rhythm.Report of two surgically treated patients.Ann Cardiol Angeiol (Paris), 1990, 39(8):467-470.
7.	Juillard J, Paillole C, Dahan M, et al.Late thrombotic obstruction of an aortic bioprosthetic valve:Successful treatment by oral anticoagulation.Clin Cardiol, 1993, 16(2):152-154.
8.	Diamant M, Jaarsma W, Morshuis WJ.Thrombolytic therapy for thrombosis of an aortic bioprosthetic valve.N Engl J Med, 1994, 330(26):1906-1907.
9.	Oliver JM, Gallego P, Gonzalez A, et al.Bioprosthetic mitral valve thrombosis:clinical profile, transesophageal echocardiographic features, and follow-up after anticoagulant therapy.J Am Soc Echocardiogr, 1996, 9(5):691-699.
10.	Capodilugo R, Plehn J.Detection of thrombotic cuspal obstruction of an aortic bioprosthesis with transesophageal echocardiography.J Am Soc Echocardiogr, 1997, 10(6):685-688.
11.	Thomas B, Carreras F, Borras X, et al.An unusual case of biopros-thetic mitral valve thrombosis.Ann Thorac Surg, 2001, 72(1):259-261.
12.	Korkolis DP, Passik CS, Marshalko SJ, et al.Early bioprosthetic mitral valve "pseudostenosis" after complete preservation of the native mitral apparatus.Ann Thorac Surg, 2002, 74(5):1689-1691.
13.	Eichinger WB, Botzenhardt F, Gunzinger R, et al.European experience with the Mosaic bioprosthesis.J Thorac Cardiovasc Surg, 2002, 124(2):333-339.
14.	Edmond JJ, Greaves SC, French JK, et al.Thrombotic risk in patients with aortic bioprostheses.J Heart Valve Dis, 2004, 13(3):525-528.
15.	Källner G, Lindblom D, Ivert T.Unusual cause of aortic biopros-thesis dysfunction.Eur J Cardiothorac Surg, 2006, 29(6):1048.
16.	Nakao M, Lim SL, Chua YL.Bioprosthetic mitral valve thrombosis in a patient in sinus rhythm after the radiofrequency maze procedure.J Thorac Cardiovasc Surg, 2006, 132(6):1464-1465.
17.	Aminian A, Lefebvre P, Delmotte P, et al.An unusual case of late bioprosthetic mitral valve thrombosis successfully managed with anticoagulation.Eur J Echocardiogr, 2008, 9(3):399-400.
18.	Nishida K, Fukuyama O. "Reversible" late bioprosthetic aortic valve stenosis with spontaneous recovery.Hawaii Med J, 2009, 68(10):243-245.
19.	Saeed O, Williams BR Jr, Ku M, et al.Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure:a case report.J Cardiothorac Surg, 2010, 5(1):18-21.
20.	Ohnaka M, Nishimura K, Kurokawa S.Flat fibrin thrombus deposition on tissue valve after aortic valve replacement.Ann Thorac Surg, 2010, 89(6):2032-2034.
21.	Pozsonyi Z, Lengyel M.Successful thrombolysis of late, non-obstructive mitral bioprosthetic valve thrombosis:case report and review of the literature.J Heart Valve Dis, 2011, 20(5):526-530.
22.	Jamieson WR, Lewis CT, Sakwa MP, et al.St Jude Medical Epic porcine bioprosthesis:results of the regulatory evaluation.J Thorac Cardiovasc Surg, 2011, 141(6):1449-1454.
23.	Brown ML, Park SJ, Sundt TM, et al.Early thrombosis risk in patients with biologic valves in the aortic position.J Thorac Cardiovasc Surg, 2012, 144(1):108-111.
24.	Jander N, Kienzle RP, Kayser G, et al.Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position.Am J Cardiol, 2012, 109(2):257-262.
25.	张宝仁, 徐志云, 主编.心脏瓣膜外科学.第1版.北京:人民卫生出版社, 2007.859.
26.	李彤, 蔡振杰, 刘维永.生物瓣心瓣膜置换术后远期疗效.中国胸心血管外科临床杂志, 2006, 13(3):197-198.
27.	Zeien LB, Klatt EC.Cardiac valve prostheses at autopsy.Arch Pathol Lab Med, 1990, 114(9):933-937.
28.	Nishimura RA, Carabello BA, Faxon DP, et al.ACC/AHA 2008 Guideline update on valvular heart disease:focused update on infective endocarditis:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.J Am Coll Cardiol, 2008, 52(8):676-685.
29.	Yap KH, Murphy R, Devbhandari M, et al.Aortic valve replacement:is porcine or bovine valve better?Interact Cardiovasc Thorac Surg, 2013, 16(3):361-373.

1. Zilla P, Brink J, Human P, et al.Prosthetic heart valves:catering for the few.Biomaterials, 2008, 29(4):385-406.
2. Babin-Ebell J, Schmidt W, Eigel P, et al.Aortic bioprosthesis without early anticoagulation——risk of thromboembolism.Thorac Cardiovasc Surg, 1995, 43(4):212-214.
3. Guyatt GH, Akl EA, Crowther M, et al.Executive summary:antithro-mbotic therapy and prevention of thrombosis, 9th ed:American college of chest physicians evidence-based clinical practice guide-lines.Chest, 2012, 141(2 Suppl):7S-47S.
4. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al.Prognosis after aortic valve replacement with a bioprosthesis:predictions based on meta-analysis and microsimulation.Circulation, 2001, 103(11):1535-1541.
5. Moujir F, Martin-Duran R, Vazquez De Prada JA, et al.Dysfunction in a Hancock mitral valve bioprosthesis caused by thrombosis and resolved with heparin.Rev Esp Cardiol, 1989, 42(3):219-221.
6. Tabone X, Berdah J, Le Feuvre C, et al.Late occlusive thrombosis of mitral prosthesis with sinus rhythm.Report of two surgically treated patients.Ann Cardiol Angeiol (Paris), 1990, 39(8):467-470.
7. Juillard J, Paillole C, Dahan M, et al.Late thrombotic obstruction of an aortic bioprosthetic valve:Successful treatment by oral anticoagulation.Clin Cardiol, 1993, 16(2):152-154.
8. Diamant M, Jaarsma W, Morshuis WJ.Thrombolytic therapy for thrombosis of an aortic bioprosthetic valve.N Engl J Med, 1994, 330(26):1906-1907.
9. Oliver JM, Gallego P, Gonzalez A, et al.Bioprosthetic mitral valve thrombosis:clinical profile, transesophageal echocardiographic features, and follow-up after anticoagulant therapy.J Am Soc Echocardiogr, 1996, 9(5):691-699.
10. Capodilugo R, Plehn J.Detection of thrombotic cuspal obstruction of an aortic bioprosthesis with transesophageal echocardiography.J Am Soc Echocardiogr, 1997, 10(6):685-688.
11. Thomas B, Carreras F, Borras X, et al.An unusual case of biopros-thetic mitral valve thrombosis.Ann Thorac Surg, 2001, 72(1):259-261.
12. Korkolis DP, Passik CS, Marshalko SJ, et al.Early bioprosthetic mitral valve "pseudostenosis" after complete preservation of the native mitral apparatus.Ann Thorac Surg, 2002, 74(5):1689-1691.
13. Eichinger WB, Botzenhardt F, Gunzinger R, et al.European experience with the Mosaic bioprosthesis.J Thorac Cardiovasc Surg, 2002, 124(2):333-339.
14. Edmond JJ, Greaves SC, French JK, et al.Thrombotic risk in patients with aortic bioprostheses.J Heart Valve Dis, 2004, 13(3):525-528.
15. Källner G, Lindblom D, Ivert T.Unusual cause of aortic biopros-thesis dysfunction.Eur J Cardiothorac Surg, 2006, 29(6):1048.
16. Nakao M, Lim SL, Chua YL.Bioprosthetic mitral valve thrombosis in a patient in sinus rhythm after the radiofrequency maze procedure.J Thorac Cardiovasc Surg, 2006, 132(6):1464-1465.
17. Aminian A, Lefebvre P, Delmotte P, et al.An unusual case of late bioprosthetic mitral valve thrombosis successfully managed with anticoagulation.Eur J Echocardiogr, 2008, 9(3):399-400.
18. Nishida K, Fukuyama O. "Reversible" late bioprosthetic aortic valve stenosis with spontaneous recovery.Hawaii Med J, 2009, 68(10):243-245.
19. Saeed O, Williams BR Jr, Ku M, et al.Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure:a case report.J Cardiothorac Surg, 2010, 5(1):18-21.
20. Ohnaka M, Nishimura K, Kurokawa S.Flat fibrin thrombus deposition on tissue valve after aortic valve replacement.Ann Thorac Surg, 2010, 89(6):2032-2034.
21. Pozsonyi Z, Lengyel M.Successful thrombolysis of late, non-obstructive mitral bioprosthetic valve thrombosis:case report and review of the literature.J Heart Valve Dis, 2011, 20(5):526-530.
22. Jamieson WR, Lewis CT, Sakwa MP, et al.St Jude Medical Epic porcine bioprosthesis:results of the regulatory evaluation.J Thorac Cardiovasc Surg, 2011, 141(6):1449-1454.
23. Brown ML, Park SJ, Sundt TM, et al.Early thrombosis risk in patients with biologic valves in the aortic position.J Thorac Cardiovasc Surg, 2012, 144(1):108-111.
24. Jander N, Kienzle RP, Kayser G, et al.Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position.Am J Cardiol, 2012, 109(2):257-262.
25. 张宝仁, 徐志云, 主编.心脏瓣膜外科学.第1版.北京:人民卫生出版社, 2007.859.
26. 李彤, 蔡振杰, 刘维永.生物瓣心瓣膜置换术后远期疗效.中国胸心血管外科临床杂志, 2006, 13(3):197-198.
27. Zeien LB, Klatt EC.Cardiac valve prostheses at autopsy.Arch Pathol Lab Med, 1990, 114(9):933-937.
28. Nishimura RA, Carabello BA, Faxon DP, et al.ACC/AHA 2008 Guideline update on valvular heart disease:focused update on infective endocarditis:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.J Am Coll Cardiol, 2008, 52(8):676-685.
29. Yap KH, Murphy R, Devbhandari M, et al.Aortic valve replacement:is porcine or bovine valve better?Interact Cardiovasc Thorac Surg, 2013, 16(3):361-373.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Reason Analysis and Prevention of Late Bioprosthetic Heart Valve Thrombosis

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