Author + information
- Alexander C. Egbe,
- Heidi Connolly,
- Patricia Pellikka,
- Vuyisile Nkomo and
- Sorin Pislaru
Background: Limited data exist about bioprosthetic valve thrombosis (BPVT).
Methods: Prospective study of patients with suspected BPVT and treated with warfarin at Mayo Clinic, 2013-2016. The study objective was to determine response to anticoagulation therapy defined as a 50% reduction in prosthesis gradient; and to assess the performance of BPVT score in predicting response to therapy.
BPVT score was calculated using previously described echocardiographic criteria. One point was assigned for each of these 3 criteria: 50% increase in prosthetic gradient within 5 years of implantation, increased cusp thickness, and abnormal cusp motion.
Results: Cohort of 52 patients; age 61±18 years. Median time to BPVT was 34 (13-80) months. Prosthesis positions were aortic 31 (60%), mitral 17 (32%), pulmonary 2 (4%) and tricuspid 2 (4%). A positive response occurred in 43 (83%) within 11 (6-22) weeks of warfarin therapy. Nine (17%) patients did not respond to warfarin. Surgical valve replacement was performed in 5; pathology showed pannus formation (n=4) and calcification (n=1). Transcatheter mitral valve-in-valve replacement was performed in one patient; 3 patients did not undergo reoperation.
BPVT score was calculated for 48 (92%) patients with good quality echocardiographic images; 9 had BPVT score of 2 while 39 had BPVT score of 3. A BPVT score of 3 predicted a positive response to anticoagulation therapy with a sensitivity of 88% and specificity of 93%.
Conclusions: A trial of anticoagulation was effective in 83% of patients with suspected BPVT, and most patients responded within 3 months. BPVT score was predictive of response to therapy and should be considered during patient selection.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-3:55 p.m.
Session Title: Prosthetic Valve Thrombosis: TAVR, Bio, Mech… Now What?!
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1260M-03
- 2017 American College of Cardiology Foundation