Prosthetic valve thrombosis.

Background: We conducted a retrospective, single center study to evaluate the clinical characteristics and outcomes of all consecutive patients with prosthetic valve thrombosis (PVT) over a 10 year period.

Methods: Data from 85 episodes of PVT in 80 patients treated over a 10-year period between 2001 and 2011 were analyzed. The diagnosis of PVT was confirmed by echocardiography and/or fluoroscopy. PVT was considered obstructive if there was an increased pressure gradient on the echo study or reduced or fixed leaflet mobility on fluoroscopy. The primary treatment approaches included: redo surgery or thrombolysis for obstructive PVT and the intensification of anticoagulation in nonobstructive PVT.

Results: The mean age was 49.4 ± 13.1 years (range: 13-79) and 40% were male. Thrombosed valves included 53 mitral, 22 aortic, six tricuspid, and both mitral and aortic position in nine patients. Subtherapeutic INR (less than 2.5) was observed in 58 patients (68.2%). Ten patients died before any definite therapeutic strategy in obstructive PVT. In ten patients, episodes were considered nonobstructive. Sixteen patients received fibrinolysis (streptokinase) that was successful in nine patients (56.2%). Intracranial hemorrhage occurred in three (18.7%) patients, and there were four deaths in this group. In the surgical group, 49 patients underwent operation as first line therapy and seven patients after failed thrombolysis. One brain hemorrhage and three (5.3%) deaths occurred during or after surgery. Total complications were significantly less frequent in the surgery group compared with those in the thrombolytic group (14.2% vs. 68.7%, p-value < 0.001). Higher NYHA functional class and lower systolic blood pressure were associated with in-hospital mortality.

Conclusion: Thrombolysis is less effective and has more complications compared to surgery in treatment of obstructive PVT. Compromised hemodynamic status during presentation of these patients denotes higher in-hospital mortality.