# Oxidative Stress Related to Mechanical Heart Valves: A Pilot Cross-Sectional Study

## TL;DR

This study found that mechanical heart valves in the mitral position cause higher oxidative stress and platelet activation than those in the aortic position, which may explain increased blood clot risks.

## Contribution

The study is the first to show a direct link between oxidative stress and platelet activation in patients with mechanical heart valves.

## Key findings

- Mitral mechanical heart valves are associated with significantly higher oxidative stress markers compared to aortic valves.
- Platelet activation is elevated in mitral valve patients and correlates with oxidative stress levels.
- These findings suggest a potential for tailored management strategies based on valve position.

## Abstract

Background: Valvular heart disease remains a major global health issue, with mechanical prosthetic heart valves (MPHVs) widely used in surgical valve replacement. However, these devices carry a risk of thrombosis, particularly in the mitral position. Several mechanisms may be involved in this risk, but the role of oxidative stress (OxS) remains unclear. Our aim was to assess the relationship between OxS impairment and platelet activation. Methods: We analyzed data from a pilot, observational, monocentric study conducted at our anticoagulation clinic at Sapienza University of Rome, involving adult patients with MPHVs (aortic or mitral) on vitamin K antagonist therapy, enrolled between June and September 2024. Clinical data and blood samples were collected to evaluate markers of NOX2-mediated OxS (sNOX2-dp, H2O2) and platelet activation (sCD40L) using ELISA-based assays. Results: Our cohort included 30 patients with mitral MPHVs and 30 patients with aortic MPHVs (46.7% males, 53.3% females). Serum sNOX2-dp and H2O2 were significantly higher in patients with mitral MPHVs (28.69 [25.08–33.18] vs. 24.27 [17.30–26.41] pg/mL, p = 0.001, and 22.94 [15.79–27.33] vs. 16.73 [12.50–20.87] µM, p = 0.013, respectively) compared with aortic MPHV patients. sCD40L was significantly elevated in mitral versus aortic MPHVs (5.61 [3.69–6.89] vs. 3.65 [2.14–5.54] ng/mL, p = 0.009). Spearman’s correlation analysis showed a significant correlation between sNOX2-dp levels and sCD40L in both groups (mitral MPHVs: rs = 0.521, p = 0.003; aortic MPHVs: rs = 0.443, p = 0.014). Conclusions: Mitral MPHVs are associated with heightened OxS and platelet activation compared to aortic MPHVs. These findings may help explain the higher thrombotic risk observed with mitral valves and support differential management strategies.