Bioprosthetic Valve Thrombosis Versus Structural Failure: Clinical and Echocardiographic Predictors
Bioprosthetic valve thrombosis (BPVT) is considered uncommon, as it is often unrecognized. According to recent data, BPVT responds to vitamin K antagonists, emphasizing the need for reliable diagnosis.
Mayo Clinic researchers, first author Sorin Pislaru, M.D., Ph.D., conducted a study to determine the diagnostic features of BPVT and to formulate a diagnostic model for BPVT. The study was published in the Journal of the American College of Cardiology.
For the study, cases of BPVT occurring between 1997 and 2013 were identified from the Mayo Clinic pathology database. Patients with BPVT were matched for age, sex, and prosthesis position with patients whose valves were explanted for structural failure. Mayo Clinic researchers formulated a diagnostic model for BPVT using multivariate linear logistic regression and receiver operating characteristic.
Based on the results, BPVT is not uncommon and can occur several years after surgery. Likely predictors of this complication include a less than 50 percent increase in mean echo-Doppler transvalvular gradient within five years, paroxysmal atrial fibrillation, subtherapeutic INR in patients anticoagulated with vitamin K antagonists, increased cusp thickness, and abnormal cusp mobility. However, additional studies are needed to validate these predictors of thrombosis in broad populations of patients with BPVT.