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Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study
Mehmet Özkan1, Sabahattin Gündüz2, Ahmet Güner3
1Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey; Ardahan University, Faculty of Health Sciences, Ardahan, Turkey.
Journal of the American College of Cardiology
|March 11, 2022
Summary
This study found that low-dose thrombolytic therapy (TT) using tissue plasminogen activator (t-PA) is a safe and effective treatment for obstructive prosthetic valve thrombosis (PVT), with high success rates and low complication rates compared to surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Prosthetic valve thrombosis (PVT) is a serious complication following heart valve replacement.
- Optimal treatment strategies for obstructive PVT, particularly thrombolytic therapy (TT) versus surgery, remain debated due to limited evidence.
Purpose of the Study:
- To prospectively evaluate and compare the outcomes of TT and surgical intervention as primary treatments for obstructive PVT.
- To assess the efficacy and safety of low-dose, slow-infusion tissue plasminogen activator (t-PA) in managing obstructive PVT.
Main Methods:
- A multicenter observational prospective study involving 158 patients with obstructive PVT.
- Patients received either TT (slow/ultraslow infusion of low-dose t-PA) or surgery as their initial treatment.
- The primary endpoint was 3-month mortality, with secondary endpoints including complication rates.
Main Results:
- Thrombolytic therapy (TT) was successful in 90.4% of cases, with a median t-PA dose of 59 mg.
- TT group experienced significantly lower rates of minor complications (8.4% vs. 38.7%) and major complications (6% vs. 41.3%) compared to the surgery group.
- The 3-month mortality rate was substantially lower in the TT group (2.4% vs. 18.7%) than in the surgery group.
Conclusions:
- Low-dose, slow/ultraslow infusion of t-PA is associated with high success rates, low complication rates, and reduced mortality in obstructive PVT.
- This TT approach should be considered a viable and effective first-line treatment option for obstructive prosthetic valve thrombosis.
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