Autoimmune-associated early double bioprosthetic valve failure: A case report

Abstract

Introduction

Bioprosthetic heart valves (BHVs) are increasingly used in valvular heart disease, offering favourable haemodynamics and lower thrombogenic risk compared to mechanical valves. However, long-term durability remains limited by structural valve degeneration (SVD).

Case report

A 70-year-old male presented with severe heart failure 4 years after bioprosthetic mitral and aortic valve replacement. Imaging confirmed SVD affecting both valves, necessitating high-risk redo surgery. Postoperatively, the patient developed profound systemic inflammatory response syndrome (SIRS) to cardiopulmonary bypass (CPB), refractory to vasopressors and steroids, and died within 24 hours.

Discussion

Further investigations revealed elevated isolated anti-cardiolipin IgM antibodies, raising suspicion of autoimmune-mediated valve thrombosis as a contributor to this case of early SVD.

Conclusion

This case highlights the importance of thorough diagnostic evaluation in cases of early SVD, the need to individualise anticoagulation strategies in at-risk patients, and serves as a critical reminder of the serious inflammatory complications that can occur post-surgery.