Epidemiological, Clinical, Etiological and Therapeutic Profile of Prosthesis Dysfunction

Abstract

Introduction: Prosthetic heart valves have dramatically improved the prognosis of valvular heart disease, especially in countries with a high prevalence of rheumatic fever. However, prosthetic valve replacement remains associated with significant complications, including valve dysfunction, particularly when anticoagulation is suboptimal. Understanding and properly managing prosthetic valve dysfunction is crucial to reducing morbidity and mortality. Aim: To investigate the epidemiological, clinical, etiological, and therapeutic characteristics of prosthetic valve dysfunction at a tertiary cardiac centre in Morocco. Methods: A retrospective study was conducted over four years (January 2020–January 2025), including 31 patients diagnosed with mechanical prosthetic valve dysfunction. Results: Mean age was 45.8 ± 12.4 years, with female predominance (sex ratio = 0.55). Mean time from prosthesis implantation to dysfunction was 7.4 ± 3.2 years. Dyspnea was the most common presenting symptom (80.6%). The main etiologies were thrombosis (38.7%), pannus formation (22.6%), prosthetic detachment (16.1%), and infective endocarditis (12.9%). INR was subtherapeutic in most patients (mean 1.8 ± 0.6). Treatment was surgical in 58% of cases, medical ± fibrinolysis in 32%, and conservative in 10%. In-hospital mortality was 6.4%. Conclusion: Thrombosis and pannus remain the leading causes of mechanical prosthetic dysfunction. Optimised anticoagulation, systematic follow-up, and early detection are essential to improve patient outcomes.