Hemolysis Associated With Prosthetic Heart Valves

Hemolysis is one of the potentially serious complications of prosthetic heart valves. It is usually associated with either structural deterioration or paravalvular leak. Mild, compensated hemolysis associated with mechanical heart valves is not uncommon even in the current era. Severe hemolysis is rare, however, and usually reflects paravalvular leak. The use of transesophageal echocardiography–guided operative techniques may help prevent or minimize early postoperative paravalvular leakage. There is a gamut of available therapeutic approaches—medical, transcatheter, and surgical—to this complication and therapy should be tailored to the individual patient. Novel pharmacological agents include erythropoietin and pentoxifylline. Several reports described the feasibility of transcatheter closure of paravalvular leak with coils or devices, but their effect on hemolysis is unpredictable. Surgery remains the treatment of choice in severe cases.