Continued Comprehensive (Level I) Valve Center Primary (Level II) Valve Center CLINICAL STATEMENTS AND GUIDELINES for early postprocedural issues, long-term medical therapy, monitoring of the prosthetic valve or repair, management of concurrent cardiac conditions, and persistent symptoms or functional limitation. Endo- carditis prophylaxis is discussed in Section 2.4.2; an- tithrombotic therapy for prosthetic valves in Sections 11.2 to 11.5; and prosthetic valve complications, in- cluding valve thrombosis, stenosis, or regurgitation, in Sections 11.6 to 11.8. 2.7.1. Procedural Complications The most common complication early after surgical valve replacement is postoperative AF, which occurs in up to one-third of patients within 3 months of sur- gery (see Sections 2.4.3 and 14.1). Other complications include stroke, vascular and bleeding complications, pericarditis, heart block requiring temporary or perma- nent pacing (especially after AVR), HF, renal dysfunc- tion, and infection. Complications after transcatheter interventions depend on the specific procedure but can include the need for permanent pacing, paravalvular leak, stroke, vascular complications, and residual valve dysfunction. 2.7.2. Primary and Secondary Risk Factor Evaluation and Treatment Concurrent coronary artery disease (CAD) is common in adults with VHD. Management of CAD at the time of valve intervention is discussed in Section 14.2. Af- ter valve intervention, evaluate and treat patients with CAD risk factors according to current guidelines for primary and secondary prevention. Although there is no convincing evidence that treating CAD risk factors will reduce the likelihood of progressive valve dysfunc- tion after intervention, cardiovascular outcomes are im- proved overall because of a reduced rate of coronary events. 2.7.3. Persistent Symptoms After Valve Intervention Persistent symptoms occur in many patients after valve intervention. The first step in evaluation is to as- sess valve function to ensure symptoms are not caused by persistent or recurrent stenosis, regurgitation, or a valve complication. 