Related Experiment Videos
Haemolysis after mitral valve replacement with the Björk-Shiley and the Lillehei-Kaster disc valve prosthesis
Insights
This study found significant intravascular hemolysis in patients with Björk-Shiley and Lillehei-Kaster mitral valve prostheses. While generally of little clinical significance, Lillehei-Kaster valves showed slightly higher red blood cell breakdown.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Biomaterials Science
Background:
- Mitral valve replacement is a common cardiac procedure.
- Mechanical heart valves, such as Björk-Shiley and Lillehei-Kaster prostheses, are used to restore valve function.
- Intravascular hemolysis, the breakdown of red blood cells within blood vessels, can be a complication of mechanical heart valves.
Purpose of the Study:
- To investigate the incidence and severity of intravascular hemolysis in patients with Björk-Shiley tilting disc and Lillehei-Kaster pivoting disc prostheses in the mitral position.
- To compare the hemolytic effects of these two types of mechanical mitral valve prostheses.
Main Methods:
- Study included 33 patients with Björk-Shiley and 34 patients with Lillehei-Kaster mitral valve prostheses.
- Evaluations were conducted 12 to 24 months post-operation.
- Laboratory tests included serum haptoglobin, serum lactate dehydrogenase, serum bilirubin, and hemoglobin levels.
Main Results:
- Significant intravascular hemolysis was detected in 85% of patients.
- Haptoglobin was absent or reduced in 72% of patients.
- Elevated serum lactate dehydrogenase (LDH) was found in 43% of patients, with moderate increases not correlated with prosthesis blood flow or gradient.
- Hemoglobin and serum bilirubin levels were mostly normal.
- LDH levels were significantly higher in patients with Lillehei-Kaster prostheses compared to Björk-Shiley prostheses.
Conclusions:
- Intravascular hemolysis, while present in most patients, was of minor clinical significance.
- The Lillehei-Kaster prosthesis demonstrated a slightly greater impact on red blood cell lifespan compared to the Björk-Shiley prosthesis.
- Further investigation into the specific design features contributing to these differences is warranted.
Abstract:
The present study reports on the incidence and degree of intravascular haemolysis in 33 patients with Björk-Shiley tilting disc prosthesis and in 34 patients with Lillehei-Kaster pivoting disc valve prosthesis in the mitral position examined 12 to 24 months after the operation. Serum haptoglobin, serum lactate dehydrogenase, serum bilirubin, and haemoglobin estimations were performed. Significant haemolysis was detected in 85 per cent of the patients. Haptoglobin was absent or reduced in 72 per cent, while raised values for serum lactate dehydrogenase were found in 43 per cent. The increase in lactate dehydrogenase was moderate and showed no correlation with blood flow through the prosthesis or with the gradient across the prosthesis. Most patients had normal haemoglobin and normal serum bilirubin values. Although intravascular haemolysis was of little clinical significance, the increase in lactate dehyrdrogenase was significantly higher in patients with the Lillehei-Kaster prosthesis than in patients with the Björk Shiley prosthesis, indicating a slightly shorter red cell lifespan in the former group. The possible reasons for the difference between the two groups are discussed.