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Occurrence, diagnosis and treatment of thromboses of heart valve prostheses
Insights
Björk-Shiley mechanical heart valve thrombosis occurred at a rate of 0.36% per patient year, necessitating reoperation. Successful reoperations prevented recurrence, highlighting the importance of anticoagulation management.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Björk-Shiley mechanical heart valves were widely implanted between 1978 and 1985.
- Thrombosis is a known complication associated with mechanical heart valves.
- Different designs of Björk-Shiley valves exist, including flat disc and convexo-concave types.
Purpose of the Study:
- To report the incidence of thrombosis in Björk-Shiley heart valve prostheses.
- To evaluate the outcomes of reoperation for valve thrombosis.
- To compare thrombosis rates between different Björk-Shiley valve designs.
Main Methods:
- Review of 667 Björk-Shiley heart valve implantations from 1978-1985.
- Analysis of 6 reoperations performed due to valve thrombosis.
- Clinical and radiological assessment for diagnosis of thrombosis.
Main Results:
- Six reoperations for thrombosis were performed, with a thrombosis rate of 0.36% per patient year.
- All reoperations were successful, with no recurrence of thrombosis in the reoperated patients.
- Thrombosis occurred exclusively in the flat disc Björk-Shiley valve type; no cases were observed in the convexo-concave type used since 1981.
Conclusions:
- Strict anticoagulation management is crucial for preventing Björk-Shiley valve thrombosis.
- Urgent reoperation is the preferred treatment for diagnosed disc valve thrombosis over thrombolysis.
- The convexo-concave Björk-Shiley valve design may have a lower risk of thrombosis compared to the flat disc type.
Abstract:
In the period from 1978 to 1985, the authors implanted a total of 667 Björk-Shiley heart valve prostheses. In the same period, they performed 6 times reoperation for thrombosis of these valves. There was one reoperation for thrombosis per 271 years of life with a valve prosthesis, i.e. 0.36% per patient year. All 6 reoperations were successful and there was until now no recurrence of thrombosis in any of the reoperated patients. All cases involved were thrombosis of the flat disc Björk-Shiley valve. There was now no thrombosis of convexo-concave types, which the authors have been using since 1981. The most important preventive measure against the development of thrombosis is strict observance and control of anticoagulation regimen. Thrombosis of a disc valve prosthesis can in most cases be diagnosed on the basis of the clinical picture and X-ray evidence of restricted disc mobility. Diagnosis of thrombosis is an indication for urgent reoperation, which is preferred to an uncertain attempt at thrombolysis.