Prosthetic valve associated hemolysis is more with paravalvular leak, endocarditis and structural failure in bioprosthetic valve. Prosthetic valve dehiscence is an important cause for prosthetic valve associated hemolysis .
Control of hypertension with beta blockers can reduce hemolysis as the shear stress reduced. One of the earlier studies used propranolol to reduce hemolysis in patients with aortic prosthetic valve . Three of the five patients given propranolol in their study had a clear decrease in hemolysis. One of their patients developed congestive heart failure with propranolol therapy at 6 months. They hypothesised that the slower heart rate was the mechanism of reduced hemolysis in their cases. Benefit of beta blocker therapy has been documented by other authors as well . They noted an increase in hemoglobin level from 9.7 g/dl to 12.4 g/dl over a 3 month periods. We also have personal experience of significant decrease in hemolysis with beta blocker therapy over a period of time.
Significant paravalvar leak has to be closed, either surgically or with device ; PDA device has been used to close paravalvar leak. Percutaneous closure of paravalvar leak is a time consuming procedure, though technically feasible in selected cases. Some cases have incomplete closure and may need a second procedure, while rare cases can have hemolysis even after the first device closure attempt . Some with residual leak may need repeated blood transfusions over a long period.