Thrombotic obstruction of Bjork-Shiley valves — diagnostic and surgical considerations

Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta‐analysis

“…Forty‐eight studies were included ( n = 2239) (Table ). There were 27 studies or study arms evaluating cohorts of patients that underwent surgery for prosthetic heart valve thrombosis ; mean age 45.2 years, 38.9% were male. There were 26 studies or study arms evaluating cohorts of patients that received thrombolytic therapy ; mean age 43.8 years, 36.3% were male.…”

“…Forty-eight studies were included (n = 2239) [2, ( Table 1). There were 27 studies or study arms evaluating cohorts of patients that underwent surgery for prosthetic heart valve thrombosis [17][18][19][20][21][23][24][25][26][27]30,31,33,35,36,39,42,43,[47][48][49][50]53,55,[57][58][59]; mean age 45.2 years, 38.9% were male. There were 26 studies or study arms evaluating cohorts of patients that received thrombolytic therapy [2,16,19,22,[27][28][29]31,32,34,37,38,40,41,[44][45][46][47]49,51,…”

“…In our study, it was possible to evaluate confounding by indication in the majority of papers. In the case of surgical treatment papers, in 13 out of 19 papers the authors clearly stated that, in their centres, surgery was the first-line option for treating patients admitted with prosthetic heart valve thrombosis [20,21,[23][24][25]30,35,39,43,50,53,55,59]. In the case of thrombolytic treatment, 15 out of 21 papers clearly stated that, in their centres, thrombolysis is the first option to treat all these patients [16,22,28,32,34,37,38,40,41,44,51,52,54,56,60].…”

“…There were only 38 cases of cage-ball valves in the surgical group without information on mortality. Only in five studies that evaluated thrombolytic therapy [29,38,41,51,52,56] and seven studies on surgical therapy [20,24,33,35,50,53,58] was it possible to separate the type of prosthesis implanted (monoleaflet versus double-leaflet) and mortality. In the thrombolytic group, mortality was 4.2% (1.5-11.5%) in the double-leaflet prosthesis subgroup and 6.8% (3.6-12.6%) in monoleaflet prosthesis subgroup (P = 0.44).…”

Could It Happen Again?

“…These early models were prone to thrombosis, however. 8 To reduce this tendency, the company developed a convexo-concave disc called the BSCC valve (the original was plano-convex) that washed better in the bloodstream, reducing the potential for thrombus formation. The BSCC disc was constrained within the device by inlet and outlet struts.…”