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Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study.
J Thorac Cardiovasc Surg. 2002 Mar; 123(3):550-6.JT

Abstract

OBJECTIVE

A prospective clinical study was designed to assess the frequency and severity of intravascular hemolysis in patients with new-generation, normally functioning prosthetic heart valves.

METHODS

Hemolysis was evaluated in 172 patients with a mechanical prosthesis (53 CarboMedics and 119 Sorin Bicarbon) and in 106 patients with a bioprosthesis (15 St Jude Medical Toronto, 19 Baxter Perimount, and 72 Medtronic Mosaic) in the aortic position, mitral position, or both. Aortic valve replacement was performed in 206 patients, mitral valve replacement in 59 patients, and double valve replacement in 13 patients. The presence of hemolysis was assessed on the basis of the level of serum lactic dehydrogenase and serum haptoglobin and the presence and amount of reticulocytes and schistocytes in the peripheral blood. Severity of intravascular hemolysis was estimated on the basis of serum lactic dehydrogenase. Clinical, echocardiographic, and hematologic evaluations were performed 1, 6, and 12 months after discharge.

RESULTS

None of the 278 patients experienced decompensated anemia, whereas at 12 months, mild subclinical hemolysis was identified in 49 patients, 44 (26%) with a mechanical prosthesis and 5 (5%) with a bioprosthesis (P <.001). At multivariate analysis, independent predictors of the presence of subclinical hemolysis were mitral valve replacement (P <.001), use of a mechanical prosthesis (P =.002), and double valve replacement (P =.02). Frequency of hemolysis in patients with stented aortic bioprostheses was 3%, whereas it was absent in those with stentless valves. Among mechanical valve recipients, double versus single valve replacement (P =.04) and mitral versus aortic valve replacement (P =.05) were correlated with the presence of hemolysis; double valve recipients also showed a more severe degree of hemolysis (P =.03). In patients with a Sorin Bicarbon prosthesis, hemolysis was less frequent (22% vs 34%, P =.09) and severe (P <.001) than in those with a CarboMedics prosthesis.

CONCLUSIONS

In normally functioning prosthetic heart valves, subclinical hemolysis is a frequent finding. A low incidence of hemolysis is found in stented biologic prostheses, and it is absent in stentless aortic valves. Modifications of valve design may contribute to minimize the occurrence of hemolysis in mechanical prostheses.

Authors+Show Affiliations

Division of Cardiac Surgery, Cardio-Thoracic Department, University of Pisa Medical School, 56124 Pisa, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11882830

Citation

Mecozzi, Gianclaudio, et al. "Intravascular Hemolysis in Patients With New-generation Prosthetic Heart Valves: a Prospective Study." The Journal of Thoracic and Cardiovascular Surgery, vol. 123, no. 3, 2002, pp. 550-6.
Mecozzi G, Milano AD, De Carlo M, et al. Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study. J Thorac Cardiovasc Surg. 2002;123(3):550-6.
Mecozzi, G., Milano, A. D., De Carlo, M., Sorrentino, F., Pratali, S., Nardi, C., & Bortolotti, U. (2002). Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study. The Journal of Thoracic and Cardiovascular Surgery, 123(3), 550-6.
Mecozzi G, et al. Intravascular Hemolysis in Patients With New-generation Prosthetic Heart Valves: a Prospective Study. J Thorac Cardiovasc Surg. 2002;123(3):550-6. PubMed PMID: 11882830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study. AU - Mecozzi,Gianclaudio, AU - Milano,Aldo D, AU - De Carlo,Marco, AU - Sorrentino,Flavia, AU - Pratali,Stefano, AU - Nardi,Carmela, AU - Bortolotti,Uberto, PY - 2002/3/8/pubmed PY - 2002/4/27/medline PY - 2002/3/8/entrez SP - 550 EP - 6 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 123 IS - 3 N2 - OBJECTIVE: A prospective clinical study was designed to assess the frequency and severity of intravascular hemolysis in patients with new-generation, normally functioning prosthetic heart valves. METHODS: Hemolysis was evaluated in 172 patients with a mechanical prosthesis (53 CarboMedics and 119 Sorin Bicarbon) and in 106 patients with a bioprosthesis (15 St Jude Medical Toronto, 19 Baxter Perimount, and 72 Medtronic Mosaic) in the aortic position, mitral position, or both. Aortic valve replacement was performed in 206 patients, mitral valve replacement in 59 patients, and double valve replacement in 13 patients. The presence of hemolysis was assessed on the basis of the level of serum lactic dehydrogenase and serum haptoglobin and the presence and amount of reticulocytes and schistocytes in the peripheral blood. Severity of intravascular hemolysis was estimated on the basis of serum lactic dehydrogenase. Clinical, echocardiographic, and hematologic evaluations were performed 1, 6, and 12 months after discharge. RESULTS: None of the 278 patients experienced decompensated anemia, whereas at 12 months, mild subclinical hemolysis was identified in 49 patients, 44 (26%) with a mechanical prosthesis and 5 (5%) with a bioprosthesis (P <.001). At multivariate analysis, independent predictors of the presence of subclinical hemolysis were mitral valve replacement (P <.001), use of a mechanical prosthesis (P =.002), and double valve replacement (P =.02). Frequency of hemolysis in patients with stented aortic bioprostheses was 3%, whereas it was absent in those with stentless valves. Among mechanical valve recipients, double versus single valve replacement (P =.04) and mitral versus aortic valve replacement (P =.05) were correlated with the presence of hemolysis; double valve recipients also showed a more severe degree of hemolysis (P =.03). In patients with a Sorin Bicarbon prosthesis, hemolysis was less frequent (22% vs 34%, P =.09) and severe (P <.001) than in those with a CarboMedics prosthesis. CONCLUSIONS: In normally functioning prosthetic heart valves, subclinical hemolysis is a frequent finding. A low incidence of hemolysis is found in stented biologic prostheses, and it is absent in stentless aortic valves. Modifications of valve design may contribute to minimize the occurrence of hemolysis in mechanical prostheses. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/11882830/Intravascular_hemolysis_in_patients_with_new_generation_prosthetic_heart_valves:_a_prospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522302315435 DB - PRIME DP - Unbound Medicine ER -