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Hemolysis after mitral valve replacement with mechanical valve prostheses
M Ninomiya1, K Yagyu, Y Kaneko
1Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Insights
Mechanical mitral valve prostheses differ in their potential to cause hemolysis. Medtronic-Hall valves showed less late hemolysis compared to St. Jude Medical or CarboMedics valves in patients after mitral valve replacement.
Area of Science:
- Biomaterials Science
- Cardiovascular Surgery
- Medical Device Engineering
Background:
- Hemolysis, the destruction of red blood cells, is a potential complication following mechanical heart valve replacement.
- Understanding factors influencing prosthesis-induced hemolysis is crucial for patient outcomes.
Purpose of the Study:
- To investigate the impact of mechanical mitral valve prosthesis type, size, and orientation on hemolysis.
- To compare hemolysis levels across different mechanical mitral valve models.
Main Methods:
- Lactate dehydrogenase (LDH) levels, a marker for hemolysis, were measured in 84 patients pre-surgery, at 1 month, and in the late postoperative period.
- Analysis included Medtronic-Hall, St. Jude Medical, and CarboMedics valve types.
Main Results:
- Medtronic-Hall valves were associated with less hemolysis in the late postoperative period compared to St. Jude Medical and CarboMedics valves.
- Hemolysis patterns varied over time: Medtronic-Hall showed higher early hemolysis, while St. Jude Medical and CarboMedics exhibited increased late hemolysis.
- Increased cardiac output in the late period may exacerbate regurgitation and hemolysis with bileaflet valves.
Conclusions:
- Medtronic-Hall valves demonstrated a more favorable hemolysis profile in the late postoperative phase compared to St. Jude Medical and CarboMedics valves.
- Prosthesis type significantly influences hemolysis, with implications for long-term valve performance and patient safety.
Objective:
We evaluated effects of type, size, and orientation of mechanical mitral valve prostheses on hemolysis.
Methods:
Subjects were 84 patients who had undergone mitral valve replacement. Lactate dehydrogenase was mainly used as a marker of hemolysis and was measured before surgery, 1 month after surgery, and in the late postoperative period.
Results:
Valves used included 16 Medtronic-Hall, 32 St. Jude Medical, and 36 CarboMedics valves. Medtronic-Hall valves caused less hemolysis than St. Jude Medical or CarboMedics valves in the late postoperative period. This resulted because hemolysis due to Medtronic-Hall valves was more severe 1 month after surgery than in the late postoperative period and because hemolysis due to St. Jude Medical or CarboMedics valves was more severe in the late postoperative period than 1 month after surgery. One reason for this finding is that cardiac output was greater in the late postoperative period than 1 month after surgery, making regurgitation through the pivots of bileaflet valves more severe. The orifice area and the orientation of prostheses did not affect hemolysis.
Conclusion:
St. Jude Medical or CarboMedics valves caused more severe hemolysis than Medtronic-Hall valves in the late postoperative period.