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Intravascular haemolysis after valve replacement: comparative study between Starr-Edwards (ball valve) and
Insights
Patients with Starr-Edwards prosthetic valves showed significant intravascular hemolysis, indicated by elevated lactate dehydrogenase (LDH) levels. Björk-Shiley valve recipients experienced less hemolysis, with minimal clinical impact.
Area of Science:
- Cardiovascular Medicine
- Biomaterials Science
- Hematology
Background:
- Prosthetic heart valves are crucial for managing valvular heart disease.
- Intravascular hemolysis, the breakdown of red blood cells within blood vessels, can be a complication of prosthetic devices.
- Understanding the hemolytic potential of different prosthetic valve types is essential for patient management.
Purpose of the Study:
- To investigate the incidence and severity of intravascular hemolysis in patients with Björk-Shiley and Starr-Edwards prosthetic valves.
- To compare the hemolytic effects of these two prosthetic valve types.
- To assess the clinical significance of observed hemolysis.
Main Methods:
- Study included 74 patients with single Björk-Shiley or Starr-Edwards prosthetic valves and 18 controls with rheumatic valvar heart disease.
- Serum lactate dehydrogenase (LDH) levels were measured as a sensitive indicator of hemolysis.
- Patients were monitored for clinical signs, including haemosiderinuria and iron deficiency.
Main Results:
- Elevated LDH levels, indicative of hemolysis, were found in one-third of Björk-Shiley prosthesis patients (mean 281 IU/l).
- All 35 Starr-Edwards prosthesis patients exhibited elevated LDH (mean 859 IU/l), with significantly higher levels in aortic prostheses (mean 927 IU/l).
- Eight of 12 patients with haemosiderinuria had Starr-Edwards valves; some Starr-Edwards recipients developed iron deficiency.
Conclusions:
- Starr-Edwards prosthetic valves are associated with a higher incidence and severity of intravascular hemolysis compared to Björk-Shiley valves.
- While hemolysis was of little clinical significance in Björk-Shiley valve patients, it led to iron deficiency in some Starr-Edwards valve patients.
- Monitoring for hemolysis and iron status is recommended for patients with Starr-Edwards prosthetic valves.
Abstract:
Seventy-four patients with single prosthetic valves (Björk-Shiley or Starr-Edwards) in the mitral or aortic position and 18 controls with rheumatic valvar heart disease were investigated for evidence of intravascular haemolysis. Serum lactate dehydrogenase (LDH) was used as the most sensitive indicator of haemolysis. Raised concentrations were found in a third of 39 patients with Björk-Shiley prostheses (mean 281 IU/l) and in all 35 patients with Starr-Edwards prostheses (mean 859 IU/l. Values were considerably higher in patients with Starr-Edwards prostheses and particularly in those with aortic prostheses (mean 927 IU/l). Eight out of 12 patients with haemosiderinuria had Starr-Edwards valves. Intravascular haemolysis was of little clinical significance in patients with Björk-Shiley prostheses, but some patients with Starr-Edwards prostheses became iron deficient as a result.