[Prevention and management of dysfunction of prosthetic heart valves]

The ideal heart valve prosthesis has not been developed. The today available mechanical and biological prostheses are far from perfect concerning thrombogenesis, mechanical durability and hemodynamic performance. Failure of an implanted valve is possible due to inadequate indication, inadequate surgical technique and inadequate medical follow-up. The patient with a heart valve prosthesis must be seen as a life-long challenge for the cooperation between cardiologists and cardiac surgeons. This article describes the main causes of prosthetic heart valve dysfunction and the surgical treatment, including structural dysfunction, thrombosis, paravalvular leakage, tissue ingrowth and prosthetic valve endocarditis.