Prosthetic valve associated hemolysis

Brief Review

Prosthetic valve associated hemolysis is more with paravalvular leak, endocarditis and structural failure in bioprosthetic valve. Prosthetic valve dehiscence is an important cause for prosthetic valve associated hemolysis [1].

Control of hypertension with beta blockers can reduce hemolysis as the shear stress reduced. One of the earlier studies used propranolol to reduce hemolysis in patients with aortic prosthetic valve [2]. Three of the five patients given propranolol in their study had a clear decrease in hemolysis. One of their patients developed congestive heart failure with propranolol therapy at 6 months. They hypothesised that the slower heart rate was the mechanism of reduced hemolysis in their cases. Benefit of beta blocker therapy has been documented by other authors as well [3]. They noted an increase in hemoglobin level from 9.7 g/dl to 12.4 g/dl over a 3 month periods. We also have personal experience of significant decrease in hemolysis with beta blocker therapy over a period of time.

Significant paravalvar leak has to be closed, either surgically or with device [4]; PDA device has been used to close paravalvar leak. Percutaneous closure of para valvar leak is a time consuming procedure, though technically feasible in selected cases. Some cases have incomplete closure and may need a second procedure, while rare cases can have hemolysis even after the first device closure attempt [5]. Some with residual leak may need repeated blood transfusions over a long period.

References

  1. Kronzon I et al. Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol. 2009 Apr 28;53(17):1543-7.
  2. Santinga JT, Flora JD, Rush JB, Penner JA, Willis PW. The effect of propranolol on hemolysis in patients with an aortic prosthetic valve. Am Heart J. 1977 Feb;93(2):197-201.
  3. Aoyagi S, Fukunaga S, Tayama E, Nakamura E, Egawa N, Hosokawa Y. Benefits of a beta-blocker for intractable hemolysis due to paraprosthetic leakage. Asian Cardiovasc Thorac Ann. 2007 Oct;15(5):441-3.
  4. Rihal CS, Sorajja P, Booker JD, Hagler DJ, Cabalka AK. Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv. 2012 Feb;5(2):121-30.
  5. Pate GE, Al Zubaidi A, Chandavimol M, Thompson CR, Munt BI, Webb JG. Percutaneous closure of prosthetic paravalvular leaks: case series and review. Catheter Cardiovasc Interv. 2006 Oct;68(4):528-33.