Dissecting cuspal hematomas: a rare form of porcine bioprosthetic valve dysfunction

Large dissecting cuspal hematomas (DCHs) were present in six (3%) of 193 porcine bioprostheses (PBs) explanted at reoperation. In four mitral PBs, the DCHs contributed to valve dysfunction; in one aortic PB, DCH was the only determinant of failure, causing stenosis by cusp thickening and rigidity. In another mitral PB, DCHs were occasionally found in the setting of valve incompetence due to commissural tears. While confirming that DCHs are a potential but infrequent cause of PB failure, these observations demonstrate that they may involve PBs implanted both in mitral and aortic position and might be a complication of anticoagulation