Index of deterioration of patients with mechanical prosthetic heart valve thrombosis
Abstract Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenti...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-09-01
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| Series: | The Cardiothoracic Surgeon |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s43057-020-00033-0 |
| _version_ | 1818848088837586944 |
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| author | Ahmed Hassouna Mohamed El-Ghanam Hasan Moftah Khaled Samir Khaled Refaat |
| author_facet | Ahmed Hassouna Mohamed El-Ghanam Hasan Moftah Khaled Samir Khaled Refaat |
| author_sort | Ahmed Hassouna |
| collection | DOAJ |
| description | Abstract Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Results The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05). ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities. Conclusion The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT. |
| first_indexed | 2024-12-19T06:11:47Z |
| format | Article |
| id | doaj.art-b33a427dc209404ebfc75582f1e5adac |
| institution | Directory Open Access Journal |
| issn | 2662-2203 |
| language | English |
| last_indexed | 2024-12-19T06:11:47Z |
| publishDate | 2020-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Cardiothoracic Surgeon |
| spelling | doaj.art-b33a427dc209404ebfc75582f1e5adac2022-12-21T20:32:59ZengSpringerOpenThe Cardiothoracic Surgeon2662-22032020-09-0128111110.1186/s43057-020-00033-0Index of deterioration of patients with mechanical prosthetic heart valve thrombosisAhmed Hassouna0Mohamed El-Ghanam1Hasan Moftah2Khaled Samir3Khaled Refaat4Cardiothoracic Surgery Department, AinShams UniversityCardiothoracic Surgery Department, AinShams UniversityCardiothoracic Surgery Department, AinShams UniversityCardiothoracic Surgery Department, AinShams UniversityCardiothoracic Surgery Department, AinShams UniversityAbstract Background Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes. Results The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05). ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities. Conclusion The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.http://link.springer.com/article/10.1186/s43057-020-00033-0Prosthetic valve malfunctionProsthetic valve thrombosisMechanical valve thrombosisScoring systemsEuroScore II |
| spellingShingle | Ahmed Hassouna Mohamed El-Ghanam Hasan Moftah Khaled Samir Khaled Refaat Index of deterioration of patients with mechanical prosthetic heart valve thrombosis The Cardiothoracic Surgeon Prosthetic valve malfunction Prosthetic valve thrombosis Mechanical valve thrombosis Scoring systems EuroScore II |
| title | Index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| title_full | Index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| title_fullStr | Index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| title_full_unstemmed | Index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| title_short | Index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| title_sort | index of deterioration of patients with mechanical prosthetic heart valve thrombosis |
| topic | Prosthetic valve malfunction Prosthetic valve thrombosis Mechanical valve thrombosis Scoring systems EuroScore II |
| url | http://link.springer.com/article/10.1186/s43057-020-00033-0 |
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