Skip to main content
Download PDF

Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: a tertiary centre experience

Echo Research & Practice volume 5, pages 113–119 (2018)Cite this article

Abstract

International best practice guidelines recommend lifelong follow-up of patients that have undergone valve repair or replacement surgery and provide recommendations on the utilization of echocardiography during follow-up. However, such follow-up regimes can vary significantly between different centres and sometimes within the same centre. We undertook this study to determine the patterns of clinical follow-up and use of transthoracic echocardiography (TTE) amongst cardiologists in a large UK tertiary centre. In this retrospective study, we identified patients that underwent heart valve repair or replacement surgery in 2008. We used local postal codes to identify patients within our hospital’s follow-up catchment area. We determined the frequency of clinical follow-up and use of transthoracic echocardiography (TTE) during the 9-year follow-up period (2009–2016 inclusive). Of 552 patients that underwent heart valve surgery, 93 (17%) were eligible for local follow-up. Of these, the majority (61/93, 66%) were discharged after their 6-week post-operative check-up with no further follow-up. Of the remaining 32 patients, there was remarkable heterogeneity in follow-up regimes and use of TTE. This variation did not correlate with the prosthesis type. In summary, the frequency of clinical follow-up and use of echocardiography is highly variable in contemporary practice. Many patients are inappropriately discharged back to their family doctor with no plans for hospital follow-up. These data further support the creation of dedicated specialist heart valve clinics to optimize patient care, ensure rational use of TTE and optimize adherence with best practice guidelines.

References

  1. Chambers JB, Prendergast B, Taggart D, Westaby S, Grothier L, Arden C, Wilson J, Campbell B, Sandoe J, Gohlke-Bärwolf C, et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart 201399 1714–1716. (https://doi.org/10.1136/heartjnl-2013-303754)

    Article  Google Scholar 

  2. Lancellotti P, Rosenhek R, Pibarot P, Iung B, Otto CM, Tornos P, Donal E, Prendergast B, Magne J, La Canna G, et al. ESC working group on valvular heart disease position paper–heart valve clinics: organization, structure, and experiences. European Heart Journal 201334 1597–1606.

    Article  Google Scholar 

  3. Chambers JB, Lloyd G, Rimington HM, Parkin D, Hayes AM, Baldrock-Apps G, Topham A. The case for a specialist multidisciplinary valve clinic. Journal of Heart Valve Disease 201221 1–4.

    Google Scholar 

  4. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 201738 2739–2791.

    Article  Google Scholar 

  5. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation 2017135 e1159–e1195. (https://doi.org/10.1161/CIR.0000000000000503)

    Article  Google Scholar 

  6. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, et al. Guidelines on the management of valvular heart disease (version 2012). European Heart Journal 201233 2451–2496. (https://doi.org/10.1093/eurheartj/ehs109)

    Article  Google Scholar 

  7. Bhattacharyya S, Pavitt C, Lloyd G, Chambers JB & on behalf of the British Heart Valve Society. Provision, organization and models of heart valve clinics within The United Kingdom. QJM 2015108 113–117. (https://doi.org/10.1093/qjmed/hcu164)

    Article  CAS  Google Scholar 

  8. Chambers JB, Prendergast B, Iung B, Rosenhek R, Zamorano JL, Pierard LA, Modine T, Falk V, Kappetein AP, Pibarot P, et al. Standards defining a ‘heart valve centre’: ESC Working Group on Valvular Heart Disease and European Association for Cardiothoracic Surgery viewpoint. European Heart Journal 201738 2177–2183. (https://doi.org/10.1093/eurheartj/ehx370)

    Article  Google Scholar 

  9. Taggu W, Topham A, Hart L, Carr-White G, Sulke N, Patel NR, Lloyd G. A cardiac sonographer led follow up clinic for heart valve disease. International Journal of Cardiology 2009132 240–243. (https://doi.org/10.1016/j.ijcard.2007.11.076)

    Article  Google Scholar 

  10. Parkin DC, Chambers JB. Routine follow-up for patients with prosthetic valves: the value of a nurse-led valve clinic. British Journal of Cardiology 201219 76–78. (https://doi.org/10.5837/bjc.2012.015)

    Article  Google Scholar 

  11. Mahy IR, Dougall H, Buckley A, Jeffrey RR, Walton S, Jennings KP. Routine hospital based follow up for patients with mechanical valve prostheses: is it worthwhile? Heart 199982 520–522. (https://doi.org/10.1136/hrt.82.4.520)

    Article  CAS  Google Scholar 

  12. Mahmood I, Kallingal J, Sabtu N, Huish J, Dowdle JR. ‘Routine’ approach to follow-up and echocardiogram after a valve replacement surgery is not a clinically effective strategy. Heart 200995 A36–A37.

    Google Scholar 

  13. Isaacs AJ, Shuhaiber J, Salemi A, Isom OW, Sedrakyan A. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. Journal of Thoracic and Cardiovascular Surgery 2015149 1262–1269. (https://doi.org/10.1016/j.jtcvs.2015.01.052)

    Article  Google Scholar 

  14. Ionescu A, McKenzie C, Chambers JB. Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation. Open Heart 20152 e000275. (https://doi.org/10.1136/openhrt-2015-000275)

    Article  Google Scholar 

  15. Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Journal of Cardio-Thoracic Surgery 201752 408–417. (https://doi.org/10.1093/ejcts/ezx244)

    Article  Google Scholar 

  16. Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. European Heart Journal 201233 2403–2418. (https://doi.org/10.1093/eurheartj/ehs255)

    Article  Google Scholar 

  17. Chambers JB, Garbi M, Nieman K, Myerson S, Pierard LA, Habib G, Zamorano JL, Edvardsen T, Lancellotti P, Delgado V, et al. Appropriateness criteria for the use of cardiovascular imaging in heart valve disease in adults: a European Association of Cardiovascular Imaging report of literature review and current practice. European Heart Journal: Cardiovascular Imaging 201718 489–498. (https://doi.org/10.1093/ehjci/jew309)

    PubMed  Google Scholar 

Download references

Funding

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Department of Cardiology, University Hospital Southampton, Southampton, UK

    Bashir Alaour MD MRCP, Christina Menexi MBBS & Benoy N. Shah MD MRCP FESC

Authors
  1. Bashir Alaour MD MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Menexi MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benoy N. Shah MD MRCP FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alaour, B., Menexi, C. & Shah, B.N. Clinical and echocardiographic follow-up of patients following surgical heart valve repair or replacement: a tertiary centre experience. Echo Res Pract 5, 113–119 (2018). https://doi.org/10.1530/ERP-18-0035

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-18-0035

Key Words

Echo Research & Practice

ISSN: 2055-0464

Contact us