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Complications of prosthetic heart valves

William H Gaasch, MD
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Replacement of a diseased heart valve with a prosthetic heart valve exchanges the native disease for prosthesis-related complications [1-3]. The incidence of serious complications in appropriately managed patients with prosthetic heart valves is approximately 3 percent per year. The frequency of various complications depends upon the valve type (mechanical versus bioprosthetic) and position, and multiple clinical risk factors, including adequacy of anticoagulation and the patient’s life expectancy. Complications include embolic events, bleeding, prosthetic heart valve obstruction or stenosis, prosthetic heart valve regurgitation (valvular and paravalvular), infective endocarditis, hemolytic anemia, and patient-prosthesis mismatch.

Prosthetic valve complications are reviewed here. Issues related to the monitoring and antithrombotic therapy in patients (including pregnant women) with prosthetic valves, bleeding complications, choice of prosthetic valve, transcatheter aortic valve replacement complications, and patient-prosthesis mismatch are discussed separately. (See "Overview of the management of patients with prosthetic heart valves" and "Antithrombotic therapy for prosthetic heart valves: Management of bleeding and invasive procedures" and "Antithrombotic therapy for prosthetic heart valves: Indications" and "Management of antithrombotic therapy for a prosthetic heart valve during pregnancy" and "Surgical procedures for severe chronic mitral regurgitation" and "Choice of prosthetic heart valve for surgical replacement", section on 'Prosthetic valve-patient mismatch'.)


Thrombus forming on a prosthetic valve can be non-obstructive or obstructive, can cause clinical thromboembolic events, can occur on mechanical or bioprosthetic valves, and can occur early or late after valve surgery [4-7].

Terminology — The two complications resulting from thrombus forming on a prosthetic valve are thromboembolism and prosthetic valve thrombosis (PVT). While these complications both result from thrombus forming on a valve, clinical manifestations of thromboembolism or valve thrombosis are distinct and may occur separately or concurrently.

The term “thromboembolism” is commonly used to indicate clinical embolic events ascribed to thrombus.  

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Literature review current through: Sep 2017. | This topic last updated: Nov 16, 2016.
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