Advertisement

Analysis of Dysfunctioning Mechanical Prostheses Excised from the Mitral Valve Position

  • William C Roberts
    Correspondence
    Corresponding author: William C. Roberts, MD, Baylor Scott & White Heart and Vascular Institute, 621 N. Hall Street, Suite H-030, Dallas, Texas 75226, (214) 820-7911 Office, (214) 820-7533 Fax
    Affiliations
    Baylor Scott & White Heart and Vascular Institute

    Departments of Internal Medicine (Division of Cardiology)

    Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
    Search for articles by this author
  • Yusuf M Salam
    Affiliations
    Baylor Scott & White Heart and Vascular Institute
    Search for articles by this author
      Described herein are findings in 16 patients who had their dysfunctioning mechanical prostheses in the mitral valve position replaced. The mechanical prostheses had been in place from 2 to 157 months (mean 80). All but 1 patient had the mechanical prosthesis excised because of prosthetic stenosis or regurgitation or both secondary to prosthetic thrombus (despite warfarin therapy) on cloth-ring “pannus” overlaying the orifice or parabasilar detachment (“leak”). The dysfunction was the result of non-infected causes in 13 patients and to infective causes in 3. Three patients (19%) died in the early post-operative period; the other 13 patients survived >1 year. The prostheses were excised in a variety of methods by the explanting surgeons. The best procedure to excise the mechanical prosthesis appears to be mainly operator dependent.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Roberts WC, Salam YM. Analysis of Mechanical Prostheses Excised from the Aortic Valve Position. Am J Cardiol 2022;176:118–124

        • Roberts WC
        • Salam YM
        • Roberts CS
        Morphologic Findings in Native Mitral Valves Replaced for Isolated Acute Infective Endocarditis.
        Am J Cardiol. 2022; 162: 136-142
      2. Roberts WC, Salam YM. Aortic valve replacement for active infective endocarditis limited to the native aortic valve. Am J Cardiol 2022; 170:76–82

      3. Roberts WC, Salam YM. Examination of operatively-excised bioprostheses in the mitral valve position to determine the reason for dysfunction. Am J Cardiol 2022;172:98–106

      4. Roberts WC, Manzoori S, Hassan MH, Salam YM. Infective endocarditis involving a bioprosthesis in the aortic valve position with operative excision. Am J Cardiol 2022;174:114–119

        • Silver MD
        • Butany J
        Mechanical heart valves: methods of examination, complications, and modes of failure.
        Hum Pathol. 1987; 18: 577-585
        • Ma WG
        • Hou B
        • Abdurusul A
        • Gong DX
        • Tang Y
        • Chang Q
        • Xu JP
        • Sun HS
        Dysfunction of mechanical heart valve prosthesis: experience with surgical management in 48 patients.
        J Thorac Dis. 2015; 7: 2321-2329
        • Dangas GD
        • Weitz JI
        • Giustino G
        • Makkar R
        • Mehran R
        Prosthetic heart valve thrombosis.
        J Am Coll Cardiol. 2016; 68: 2670-2689
        • IJsselhof RJ
        • Slieker MG
        • Gauvreau K
        • Muter A
        • Marx GR
        • Hazekamp MG
        • Accord R
        • van Wetten H
        • van Leeuwen W
        • Haas F
        • Schoof PH
        • Nathan M
        Mechanical mitral valve replacement: a multicenter study of outcomes with use of 15- to 17-mm prostheses.
        Ann Thorac Surg. 2020; 110: 2062-2069
        • Seiler C
        Management and follow up of prosthetic heart valves.
        Heart. 2004; 90: 818-824
        • Roberts WC
        • Morrow AG
        Mechanisms of acute left atrial thrombosis after mitral valve replacement. Pathologic findings indicating obstruction to left atrial emptying.
        Am J Cardiol. 1966; 18: 497-503
        • Jones AA
        • Otis JB
        • Fletcher GF
        • Roberts WC
        A hitherto undescribed cause of prosthetic mitral valve obstruction.
        J Thorac Cardiovasc Surg. 1977; 74: 116-117