Videoassisted thrombectomy of mechanical prosthetic heart valves.
OBJECTIVE
Thrombosis of a bileaflet mechanical heart valve is a life-threatening clinical event. Surgical thrombectomy of bileaflet mechanical prostheses remains an appropriate treatment in selected patients.


METHODS
Between 1996 and 1998, five patients (three men, two women; average age 56 +/- 1 years; range: 56 to 66 years) with thrombosis of left-sided bileaflet mechanical valves were treated with videoassisted thrombectomy of the prosthesis. Four patients had thrombosis of a bileaflet mitral mechanical valve, and one patient had thrombosis of an aortic valve prosthesis. Preoperatively, patients were in either NYHA functional class IV (n = 4) or class I (n = 1). Surgery was performed through a right anterior thoracotomy or a median sternotomy. A rigid 30 degrees thoracoscope was inserted into the left atrium or aorta to visualize the thrombosed valve. The thrombus was extracted and the prosthesis under-surface examined and cleaned. Leaflet mobility, assessed with transesophageal echocardiography, was normal following surgical thrombectomy.


RESULTS
Mean cardiopulmonary bypass time was 102 +/- 30 min; mean aortic cross-clamping time was 47 +/- 25 min. There was no hospital mortality; mean hospital stay was 9 +/- 1 days (range: 6 to 11 days). Anticoagulation with intravenous heparin was resumed 24 h after surgery. Three patients were discharged on coumarin treatment alone; two patients received aspirin plus coumarin. Mean postoperative follow up was 7 +/- 8 months (range: 1 to 21 months). One patient died 21 months after thrombectomy of a mitral prosthesis, with an unconfirmed diagnosis of recurrent mitral valve dysfunction. At 1-15 months after surgery, four patients are in NYHA class I, without evidence of prosthesis dysfunction.


CONCLUSIONS
Videoassisted thrombectomy of a bileaflet mechanical heart valve is a treatment option in patients with acute thrombosis of the prosthesis.
Carrier
M
M
Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Pellerin
M
M
Dagenais
F
F
Perrault
L P
LP
Petitclerc
R
R
Pelletier
L C
LC
D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011474:Prosthesis Design; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
D000925:Anticoagulants