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prosthetic heart valve

Includes: - bioprosthetic heart valve - mechanical heart valve Special laboratory: - echocardiography at baseline & in patients with signs & symptoms of valve dysfunction [1] - echocardiography & 5 & 10 years after surgery & annually thereafter for patients with bioprosthetic heart valve [1] - for patients with transcatheter bioprosthetic heart valve, baseline echocardiogram & annually thereafter [1] - any change in clinical status suggesting prosthetic valve dysfunction warrants echocardiography - patients at high risk of endocarditis, thus intermittent fevers need assessment with transthoracic echocardiogram (TTE) - if TTE is negative, transesophageal echocardiogram [1] - routine monitoring with echocardiography otherwise not indicated [1] Management: - shared decision-making should guide choice of prosthetic valve type. [1] - anticoagulation with warfarin for at least 3 months for bioprosthetic valve & lifelong for mechanical valve [1] - aspirin 81 mg QD should be continued indefinitely (both valve types) - all patients with prosthetic heart valves are at increased risk for infective endocarditis & antibiotic prophylaxis should be given for dental procedures [1] - interrupt anticoagulation for non-cardiac surgery or dental procedures [1] - no interrupt of anticoagulation for cataracts surgery [1]

Related

mechanical valve thrombosis; prosthetic valve thrombosis

Specific

bioprosthetic (tissue) heart valve mechanical heart valve

General

heart valve vascular prosthesis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol. 2010 Jun 1;55(22):2413-26 PMID: 20510209
  3. Turpie AG, Gent M, Laupacis A et al A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993 Aug 19;329(8):524-9. PMID: 8336751 Free Article