Surgical treatment of prosthetic valve thrombosis: ten years' experience

Prosthetic valve thrombosis (PVT) is a rare, but serious, complication of heart valve replacement with a mechanical substitute. Herein is presented the authors' surgical experience of 18 patients with PVT.

A total of 1,584 heart valve operations was performed in 1,365 patients at the authors' institution between June 1995 and September 2005. Surgical reports of prosthetic valve reoperations over the same period were screened. Preoperative, operative and postoperative data were collected from the patient cohorts.

Since July 1997, 18 patients (12 females, six males; mean age 35.9 +/- 11.3 years; range: 22-60 years) presented with PVT. The subtherapeutic anticoagulation level was the major etiologic factor involved in the pathogenesis of PVT. Thrombosis occurred in the mitral position in 14 patients (78%), and in the aortic position in four (22%). All mechanical valves implanted were bileaflet (1,097 St. Jude Medical, 324 CarboMedics, and 163 Sorin). The mean duration from valve replacement to PVT was 48.3 +/- 15.4 months. The majority of patients presented with poor functional status (56% in NYHA class IV) and poor anticoagulation (INR < or = 2 in 72% of cases). Valve re-replacement was performed for all patients. The 30-day mortality was 16.7%.

PVT is a potentially fatal complication of heart valve replacement. These acceptable results suggest that early surgical intervention might be a safe and effective treatment of choice in patients with PVT. Patients with mechanical valve prostheses should be informed adequately about the need for, and the importance of, an effective anticoagulation regimen.