Early bioprosthetic aortic valve thrombosis: why prosthesis selection should not be underestimated — a case report

Authors

DOI:

https://doi.org/10.66636/gmj.v1.i3.a173

Keywords:

Bioprosthetic valve thrombosis, Surgical aortic valve replacement (SAVR), Bioprosthetic aortic valve dysfunction, Redo aortic valve surgery, Leaflet thrombosis, cardiac surgery, aortic valve replacement, prosthesis selection , anticoagulation, subclinical leaflet thrombosis, structural valve deterioration , case report

Abstract

Although prosthetic valve thrombosis is classically associated with mechanical valves, growing evidence suggests that bioprosthetic valve thrombosis (BPVT) is an underrecognised and clinically relevant complication that may occur more frequently than initially believed. We present the case of a 72-year-old male who developed thrombosis of a St. Jude Medical Epic™ bioprosthetic aortic valve several months after implantation. The patient developed severe prosthetic valve dysfunction characterised by elevated transprosthetic gradients and stenosis secondary to organised thrombus formation. He was admitted with acute pulmonary oedema and underwent redo surgical aortic valve replacement (SAVR) with a mechanical prosthesis. Intraoperative findings confirmed thrombus involving all three leaflets. This case emphasises the need for early recognition of BPVT, consideration of postoperative anticoagulation, and careful prosthesis selection. A literature review highlights incidence, risk factors, diagnostic strategies, and management pathways for BPVT.

Keywords: bioprosthetic valve thrombosis; aortic valve replacement; prosthesis selection; anticoagulation; subclinical leaflet thrombosis; structural valve deterioration; case report

References

1. Clarizia NA, Bapat VN, Ruel M. Current surgical bioprostheses: looking to the future. Prog Cardiovasc Dis. 2022;72:21–25. https://doi.org/10.1016/j.pcad.2022.06.005

2. Rashid HN, Gooley RP, Nerlekar N, et al. Bioprosthetic aortic valve leaflet thrombosis detected by multidetector computed tomography: a meta-analysis. EuroIntervention. 2018;13(15):1818–1825. https://doi.org/10.4244/EIJ-D-17-01062

3. Shibata K, Maeda S, Kashiyama N, Nakatsuji H, Ryugo M, Tsutsumi Y, et al. Long-term valve performance of St Jude Medical Epic porcine bioprosthesis in aortic position. J Artif Organs. 2024;27(2):131–137. https://doi.org/10.1007/s10047-023-01401-3

4. Egbe AC, Pislaru SV, Pellikka PA, et al. Bioprosthetic valve thrombosis following transcatheter valve replacement: incidence, characteristics, and treatment outcomes. JACC Cardiovasc Imaging. 2017;10(10):1173–1180. https://doi.org/10.1016/j.jcmg.2017.06.022

5. Chen F, et al. Early failure of a bioprosthetic aortic valve due to thrombus formation while on rivaroxaban. Eur J Cardiothorac Surg. 2019;55(6):1231–1233. https://doi.org/10.1093/ejcts/ezy341

6. Fan J, Lipatov K, Lane W, Mixon T. Management of bioprosthetic cardiac valve thrombosis. Proc (Bayl Univ Med Cent). 2018;31(4):496–498. https://doi.org/10.1080/08998280.2018.1494495

7. Uimonen M, Kuitunen I, Ponkilainen V, et al. Antithrombotic management after aortic valve replacement with biological prosthesis: a meta-analysis. J Cardiothorac Surg. 2024;19:385. https://doi.org/10.1186/s13019-024-02863-z

8. Heras M, Chesebro JH, Fuster V, Penny WJ, Grill DE, Bailey KR, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25(5):1111–1119. https://doi.org/10.1016/0735-1097(94)00563-6

9. Cohn LH. Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill; 2008. Reoperation valve surgery, p. 985.

10. Cohn LH. Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill; 2008. Cardiac surgical pharmacology, p. 85.

11. Cohn LH. Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill; 2008. Aortic valve diseases, p. 638.

12. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–2791. https://doi.org/10.1093/eurheartj/ehx391

13. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation. 2017;135(25):e1159–e1195. https://doi.org/10.1161/CIR.0000000000000503

14. Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves. Eur Heart J. 2017;38(45):3382–3390. https://doi.org/10.1093/eurheartj/ehx303

15. Bax JJ, Delgado V. Bioprosthetic heart valves, thrombosis, anticoagulation, and imaging surveillance. JACC Cardiovasc Interv. 2017;10(4):388–390. https://doi.org/10.1016/j.jcin.2016.12.275

16. Fatima B, Mohananey D, Khan FW, Jobanputra Y, Tummala R, Banerjee K, et al. Durability data for bioprosthetic surgical aortic valve: a systematic review. JAMA Cardiol. 2019;4(1):71–80. https://doi.org/10.1001/jamacardio.2018.4045

17. Harky A, Suen MMY, Wong CHM, Maaliki AR, Bashir M. Bioprosthetic aortic valve replacement in <50 years old patients — where is the evidence? Braz J Cardiovasc Surg. 2019;34(6):729–738. https://doi.org/10.21470/1678-9741-2018-0374

18. Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. Ann Thorac Surg. 2012;93(4):1340–1395. https://doi.org/10.1016/j.athoracsur.2012.01.084

19. Mukharyamov M, Kirov H, Golovina M, Caldonazo T, Doenst T. Long-term outcomes of the largest (29) Epic Supra aortic valve bioprosthesis: comparing recommended with upsizing implantation. Interdiscip Cardiovasc Thorac Surg. 2024;38. https://doi.org/10.1093/icvts/ivae046

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Published

08/22/2026

How to Cite

Dumani, S., Mehmeti, A., Kuci, S., Beka, V., Teliti, R., & Refatllari, A. (2026). Early bioprosthetic aortic valve thrombosis: why prosthesis selection should not be underestimated — a case report. Georgian Medical Journal, 1(3). https://doi.org/10.66636/gmj.v1.i3.a173

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