Complications-prosthetic-heart-valves

• Structural failure (r/o endocarditis); mechanical valves: rare except for Bjork-Shiley; bioprosth: up to 30% rate w/in 10–15 y, mitral >aortic; consider TAVR (JACC 2017; 69:2253)
• Paravalvular leak (r/o endocarditis); small central jet of regurg is normal in mech. valves
• Obstruction from thrombosis (JACC 2013;62:1731) or pannus: ✓ TTE, TEE, CTA, or fluoro significantly symptomatic pannus ingrowth: remove w/ surgery thrombosis: surgery if sx or large L-sided mech valve obstruction; UFH ± low-dose lytic if small, not surgical candidate, or R-sided; OAC for sx bioprosthetic thrombosis
• Infective endocarditis ± valvular abscess and conduction system dis. (see “Endocarditis”)
• Embolization (r/o endocarditis); risk highest 1st 90 d, ~1%/y w/ warfarin (vs. 2% w/ ASA, or 4% w/o meds); mech MVR 2× risk of embolic events vs. mech AVR (Circ 1994;89:635)
• Bleeding (from anticoag), hemolysis (espec w/ caged-ball valves or paravalvular leak)