Thrombolysis and surgery for mitral prosthetic valve thrombosis: 11-year outcomes

Abstract

Background Mechanical mitral valve obstruction is a serious and life-threatening complication. Treatment is either thrombolysis or reoperation, with both interventions having its own merits and drawbacks. This study aimed to analyze the outcomes of both interventions at a single tertiary referral center. Methods From January 2005 to December 2010, 127 patients with mechanical mitral valve obstruction were retrospectively analyzed and divided into a thrombolysis group ( n = 66) and a reoperation group ( n = 61), based on our institute’s inclusion and exclusion criteria. A heart valve team comprising a cardiologist, a surgeon, and the patient was involved in the decision-making, based on the criteria for thrombolysis and reoperation in our institute. The patients had a maximum follow-up period of 14 years (mean 11.2 years). The analysis was divided into in hospital (within 30 days) and follow-up outcomes. Results At the end of 10 years, the reoperation group had significantly greater freedom from embolism (100% vs. 95.4% ± 0.7%), bleeding events (94.5% ± 0.8% vs. 89.2% ± 0.4%), and reintervention (96.4% ± 0.5% vs. 92.3% ± 2.3%) as well as better actuarial survival (97.4% ± 1.2% vs. 92.3% ± 0.4%) compared to the thrombolysis group. The complete failure rate of thrombolysis was 12%. The thrombolysis group had shorter intensive care unit and hospital stays. Conclusion Reoperation has significant advantages over thrombolysis in terms of embolic and bleeding complications and reintervention. Hence one should consider surgery for stuck mechanical mitral valves, with thrombolysis being useful in a specific subset of patients.

Clinical and Surgical Evaluations of Reoperation After Mechanical Mitral Valve Replacement Due to Different Etiologies

“…Patients with thrombus in our study had a 10 years survival rate of 91.8 ± 5.5%, which was mildly lower than that reported by Raman et al (97.4 ± 1.2%) (22). Furthermore, those with pannus had a moderate survival rate (89.5%) compared with the thrombus group and PVL group, similar to findings reported by Park et al (87.6%) (23).…”

A Prospective Study on Treatment of Prosthetic Valve Thrombosis and its Clinical Presentation

“…The poor compliance was noted in maximum of the patients in this study, mirrored a lesser baseline INR on admission, as maximum cases (62%) had a subtherapeutic INR. This situation is more communal in emerging states, such as Pakistan, where most people have poor socioeconomic status [20][21] . Worldwide, the major causes of PV thrombosis are poor adherence and suboptimal anticoagulation with sub-therapeutic INR, as has been shown in many studies 22 .…”

Comparison between surgery and fibrinolytic therapy in prosthetic valve thrombosis: A systematic review and meta‐analysis

“…By titles and abstracts screening, 699 records were excluded, and full texts of 37 possible eligible articles were reviewed. Finally, after a thorough full-text review, 15 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] articles with 1235 patients (529 patients in the fibrinolytic group and 706 patients in the surgery group) were included in the meta-analysis. The flowchart presenting the selection of the articles is shown in Figure 1.…”