Prosthetic Valve Thrombosis: Fibrinolysis, Surgery, or Percutaneous Manipulation?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Biomedical Engineering

Background:

• Prosthetic valve thrombosis (PVT) is a rare but serious complication.
• Left-sided prosthetic heart valves, particularly bileaflet designs, are susceptible to thrombosis.
• Treatment strategies for PVT require careful consideration of valve type and patient factors.

Purpose of the Study:

• To evaluate the efficacy of different treatment modalities for prosthetic valve thrombosis (PVT).
• To compare outcomes of fibrinolysis versus surgical intervention for PVT.
• To analyze treatment responses based on prosthesis type and location.

Main Methods:

• Retrospective analysis of 20 cases of left-sided PVT.
• Treatment modalities included streptokinase (STK) fibrinolysis, reteplase, percutaneous mitral disk manipulation, and valve replacement surgery.
• Outcomes were assessed based on thrombosis resolution and clinical status.

Main Results:

• Streptokinase (STK) achieved excellent results in 66.6% of thrombosed St. Jude's mitral prostheses.
• Percutaneous mitral disk manipulation served as an effective adjuvant therapy.
• Reteplase showed positive outcomes for pulmonary mechanical prosthesis, but thrombosed aortic prostheses responded poorly to fibrinolysis.
• Six patients refractory to thrombolysis had successful outcomes with valve replacement surgery.
• Two high-risk patients (10%) experienced mortality.

Conclusions:

• Fibrinolytic therapy, particularly streptokinase (STK), is a viable first-line treatment for St. Jude's mitral PVT.
• Thrombosed aortic prostheses generally require surgical intervention.
• Valve replacement surgery offers an excellent alternative for patients unresponsive to thrombolysis.
• Treatment decisions for PVT should be individualized based on prosthesis type, location, and patient risk profile.