Mechanical tricuspid valve thrombosis: A midterm follow‐up study

Abstract

Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study, we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis.Methods: The current study was conducted in Rajaei Heart Center on 42 patients with mechanical TV thrombosis from 2006 to 2017. The baseline characteristics and the rates of adverse events during the follow-up period were assessed.Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5 ± 14.3 years (19-77), and overall two-thirds were female. Thrombolytic therapy was used in 41 (61.1%), anticoagulant intensification in 16 (23.9%), and surgery as the first approach in 10 (14.9%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. In-hospital mortality occurred in two (2.98%) patients. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 1, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction were 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions:The results of the present study showed that recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up.

A case of early thrombosis following a percutaneous tricuspid valve in valve implantation managed by thrombolysis

“…Another study compared five thrombolytic regimens for treating prosthetic valve thrombosis, including ten cases of the mechanical tricuspid valve, reported that ultra‐slow infusion of alteplase (25 mg over 25 h) had an overall success rate of 85% and the lowest complication rate compared to the other regimens. There have been no reported complications in patients with the heart valve in tricuspid position 19 . There are a few published articles describing the use of fibrinolysis in bioprosthetic valves, and we found only one case report of thrombolytic therapy for THV thrombosis.…”

“…There have been no reported complications in patients with the heart valve in tricuspid position . 19 There are a few published articles describing the use of fibrinolysis in bioprosthetic valves, and we found only one case report of thrombolytic therapy for THV thrombosis. Akhras et al reported a case of transcatheter mitral valve thrombosis early after the procedure and significant improvement of gradients and systolic pulmonary artery pressure 8 h after alteplase infusion at a rate of 10 mg/h.…”

“…In a therapeutic outcome study for tricuspid mechanical valve thrombosis, 41 patients received fibrinolytic therapy without experiencing intracranial or gastrointestinal bleeding and only two episodes of retroperitoneal bleeding. The success rate was 84% 19 . Another study compared five thrombolytic regimens for treating prosthetic valve thrombosis, including ten cases of the mechanical tricuspid valve, reported that ultra‐slow infusion of alteplase (25 mg over 25 h) had an overall success rate of 85% and the lowest complication rate compared to the other regimens.…”

“…The success rate was 84%. 19 Another study compared five thrombolytic regimens for treating prosthetic valve thrombosis, including ten cases of the mechanical tricuspid valve, reported that ultra-slow infusion of alteplase (25 mg over 25 h) had an overall success rate of 85% and the lowest complication rate compared to the other regimens.…”

Impact of percutaneous valve intervention on mechanical valves selection

“…To the Editor, I congratulate Shojaeifard et al 1 for their successful management of mechanical tricuspid valve thrombosis. Cardiac surgery nowadays is rapidly changing and at a crucial turning point.…”