Abstract
3/2017
vol. 14
Original paper
Late subclinical hemolysis and long-term outcomes after aortic valve replacement with On-X mechanical prostheses – a preliminary single-center report
Kardiochirurgia i Torakochurirgia Polska 2017; 14 (3): 175-179
Online publish date: 2017/10/06
Introduction: Aortic valve replacement (AVR) with a mechanical prosthesis is not free from late complications.
Aim: To evaluate the prevalence of subclinical hemolysis after AVR with On-X prostheses and assess its impact on long-term outcomes.
Material and methods: The prospective study included 84 consecutive patients aged 58.3 ±10.3 years who underwent AVR. They were retrospectively split into group H (n = 12; 14.3%) with prosthesis-related subclinical hemolysis and a control group (C; n = 72; 85.7%). All operations were performed via median sternotomy using cardio-pulmonary bypass. At the end of follow-up, echocardiography was carried out and blood samples for morphology and biochemistry (lactate dehydrogenase (LDH), bilirubin, haptoglobin) were taken.
Results: The rate of subclinical hemolysis in patients with properly working prostheses was 14.3% and it was the highest (33.3%) for the smallest valves. Although an improvement in functional status was noted in both groups, it was less evident in group H than in group C (p = 0.007). At the end of follow-up, 97.2% in group C and 75.0% in group H were found in NYHA classes I and II. Patients in group H had significantly lower hemoglobin, hematocrit, and haptoglobin and higher LDH activity than group C subjects. In group H, systolic gradients of On-X valves were higher whereas effective orifice area was smaller than in group C.
Conclusions: Our study proved that prosthesis-induced subclinical hemolysis is seen even after implantation of the latest generation mechanical prostheses, particularly of small diameter, and its degree may impact late outcome.
Aim: To evaluate the prevalence of subclinical hemolysis after AVR with On-X prostheses and assess its impact on long-term outcomes.
Material and methods: The prospective study included 84 consecutive patients aged 58.3 ±10.3 years who underwent AVR. They were retrospectively split into group H (n = 12; 14.3%) with prosthesis-related subclinical hemolysis and a control group (C; n = 72; 85.7%). All operations were performed via median sternotomy using cardio-pulmonary bypass. At the end of follow-up, echocardiography was carried out and blood samples for morphology and biochemistry (lactate dehydrogenase (LDH), bilirubin, haptoglobin) were taken.
Results: The rate of subclinical hemolysis in patients with properly working prostheses was 14.3% and it was the highest (33.3%) for the smallest valves. Although an improvement in functional status was noted in both groups, it was less evident in group H than in group C (p = 0.007). At the end of follow-up, 97.2% in group C and 75.0% in group H were found in NYHA classes I and II. Patients in group H had significantly lower hemoglobin, hematocrit, and haptoglobin and higher LDH activity than group C subjects. In group H, systolic gradients of On-X valves were higher whereas effective orifice area was smaller than in group C.
Conclusions: Our study proved that prosthesis-induced subclinical hemolysis is seen even after implantation of the latest generation mechanical prostheses, particularly of small diameter, and its degree may impact late outcome.
Keywords
aortic stenosis, aortic valve replacement, mechanical prosthesis, hemolysis, late outcome
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