A recent story in the news has raised concerns about stroke risk in people who have had heart valve replacement – specifically aortic valves made from animal tissue mostly in patients having transcatheter heart valves.
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For 30 years, surgeons have replaced faulty heart valves with prosthetic valves made from pig or cow tissue. The valves have become popular because they can be implanted through minimally invasive techniques. And, they typically don’t require patients to take blood thinners long-term. The long term results with these are excellent and without anticoagulation, only 7% showed leaflet abnormality in the New England Journal of Medicine that the recent article referenced. Tissue valves are less likely than mechanical synthetic valves to cause blood clots, say cardiovascular experts.
The study published Oct. 5 in The New England Journal of Medicine questions use of valves inserted via catheter in the groin or through a chest wall incision. Out of 55 tissue valves implanted in study participants, 22 (43 percent) didn’t function properly, according to CT scans. Potentially blood clots on the valves are to blame although this remains questionable. A smaller percentage (13 percent) of patients in two other registries showed similar valve malfunctions. There is no evidence that this imaging abnormality leads to any clinical events. This is an area of active research.
Should you be concerned – especially if you have a prosthetic tissue valve? Samir Kapadia, MD, Head of Invasive/Interventional Cardiology at Cleveland Clinic, says no.
What the studies really showed
“Out of the 22 patients with abnormal valve function in the first study, two had a stroke,” says Dr. Kapadia. “Both strokes were within one day of their transcatheter aortic valve replacement (TAVR). One of the patients had multiple risk factors for stroke, including atrial fibrillation.”
Of people in the other two registries, only one had a stroke and that patient had normal valve function.
In other words, the incidence of stroke in these studies:
- Could not be linked to abnormal valve motion
- Was not higher than in people with normal valve motion
More studies will be done. But currently there is no link between having a prosthetic valve and having a stroke.
What you should do if you have a transcatheter bioprosthetic valve
“For now, there is no reason for patients to be concerned about their valves,” says Dr. Kapadia. “If they have symptoms such as shortness of breath, palpitations, leg swelling or if we notice a valve abnormality on imaging, we will consider further testing. Overall, patients do very well after aortic valve procedures. There are no plans to change current medical practice.”
If you have a bioprosthetic valve, there is no need for you to schedule a special appointment with your physician in light of the recent study. Please continue to see your physician for routine follow-up or if you notice new symptoms.