Mechanical Hemolysis Complicating Transcatheter Interventions for Valvular Heart Disease: JACC State-of-the-Art Review

J Am Coll Cardiol. 2021 May 11;77(18):2323-2334. doi: 10.1016/j.jacc.2021.03.295.

Abstract

Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.

Keywords: heart valve disease; heart valve prosthesis; heart valve repair; hemolytic anemia; mechanical hemolysis.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization / adverse effects*
  • Cardiac Surgical Procedures / adverse effects*
  • Heart Valve Diseases / surgery*
  • Hematologic Diseases / etiology*
  • Hemolysis*
  • Humans
  • Postoperative Complications / etiology*