title: Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis.
abstract: Prosthetic valve thrombosis (PVT) is one of the most serious long-term complications after heart valve replacement, and optimal treatment remains unclear. The investigators report clinical characteristics and outcome of all consecutive patients with PVT treated with urgent surgery or thrombolysis with recombinant tissue plasminogen activator at a single center from January 1988 to December 2008. Thirty-one patients (mean age 59 years, range 20 to 75, 19% men) were diagnosed with PVT a median of 11 years after valve replacement (range 4 months to 32 years). Affected valve positions were mitral in 17 (55%), aortic in 8 (26%), and tricuspid in 6 (19%), and all but 1 were mechanical valves. Eighteen patients underwent urgent surgery, with 2 deaths in the immediate perioperative phase and 2 recurrences (11%) of PVT over a median follow-up period of 76 months. Of 13 patients treated with thrombolysis, there was immediate clinical improvement after a single administration of recombinant tissue plasminogen activator in 12 (92%), of whom 8 (61%) showed complete response with normalization of echocardiographic findings. The only nonresponder was subsequently referred for urgent surgery. Over a median follow-up period of 18 months, recurrence of PVT was seen in 4 patients (31%), with 1 fatal event in a patient refusing further anticoagulation treatment 1 week after successful thrombolysis. Other complications in the recombinant tissue plasminogen activator group included 1 stroke, 1 transient ischemic attack, 1 hemorrhagic complication requiring surgery, and 2 peripheral embolic events with spontaneous resolution. In conclusion, thrombolysis is an attractive first-line therapy for patients with PVT, with clinical outcomes comparing favorably with the standard surgical approach.
authors.affiliation: Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium.
authors.forename: Siegmund
authors.initials: S
authors.lastname: Keuleers
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
authors.forename: Bart
authors.initials: B
authors.lastname: Meuris
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.forename: Willem
authors.initials: W
authors.lastname: Flameng
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Tom
authors.initials: T
authors.lastname: Adriaenssens
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents