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Thrombolysis for prosthetic valve thrombosis: indications and results
A Renzulli1, N Vitale, A Caruso
1Institute of Cardiac Surgery, Medical School, Second University of Naples, Italy.
Insights
Thrombolysis effectively treats prosthetic valve thrombosis (PVT) with recombinant tissue type plasminogen activator (rt-PA), confirming our criteria. Recurrence was linked to more thrombogenic valve prostheses.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Prosthetic valve obstruction stems from thrombi or fibrous overgrowth.
- Thrombolysis offers an alternative to reoperation, but is clot-specific.
- Assessing thrombolysis for prosthetic valve thrombosis (PVT) is crucial.
Purpose of the Study:
- Evaluate indication criteria for thrombolysis in prosthetic valve thrombosis.
- Assess treatment outcomes and follow-up in a large patient cohort.
Main Methods:
- Retrospective analysis of 20 patients treated with recombinant tissue type plasminogen activator (rt-PA) from 1991-1994.
- Indication criteria included recent symptoms, transesophageal echocardiographic (TEE) clot evidence, and preserved disc excursion.
- Patients had mechanical valves (caged ball, tilting disc, bileaflet) in mitral or aortic positions.
Main Results:
- Successful restoration of prosthetic valve function in all patients post-rt-PA infusion.
- Transient ischemic attacks (5) and peripheral embolism (1) occurred during treatment.
- Thrombosis recurrence in 3 patients; 2 successfully retreated with thrombolysis.
Conclusions:
- The study validates the established indication criteria for thrombolysis in PVT.
- Treatment with rt-PA proved satisfactory with transient complications.
- Recurrent thrombosis was more frequent with highly thrombogenic valve prostheses.
Background And Aims Of The Study:
Prosthetic valve obstruction is caused by thrombi or fibrous tissue overgrowth, or both; thrombolysis avoids reoperation-related risks, but is effective only on clots. Hence, the study aims were to: (i) further assess our indication criteria for thrombolysis in prosthetic valve thrombosis; and (ii) evaluate treatment and follow up in a large patient population.
Methods:
Between January 1991 and January 1994, 20 cases of prosthetic thrombosis were treated with thrombolysis using recombinant tissue type plasminogen activator (rt-PA). Indication criteria for thrombolysis were: (i) recent onset of symptoms; (ii) transesophageal echocardiographic (TEE) evidence of clots on the valve or cardiac chambers; and (iii) a partially preserved disc excursion. All patients were fitted with mechanical valves (four caged balls, 10 tilting discs, six bileaflets), with 17 valves located in the mitral and three in the aortic position. Symptoms of obstruction comprised cardiac failure in 11 cases and/or embolism in 10.
Results:
After rt-PA infusion, normal prosthetic function was restored in all patients, though one underwent successful reoperation five days later. During infusion, five patients had a transient ischemic attack and one a minor transient peripheral embolism. Recurrence of thrombosis occurred in three patients during follow up; subsequent thrombolysis was successful in two, without complication.
Conclusions:
As treatment proved satisfactory, the reliability of our indicational criteria was confirmed. Only transient complications arose during treatment with recurrent thrombosis most common in those patients who had more thrombogenic valve prostheses.