title: Surgical Thrombectomy of Mechanical Valve Thrombosis.
abstract: BACKGROUND
  The study aim was to review the authors' experience with the surgical thrombectomy of mechanical valve thrombosis at the Heart Institute of the Medical School of São Paulo University, Brazil.
  
  
  METHODS
  Between January 1993 and March 2014, a total of 21 patients (16 females, five males; mean age 48.2 years) with mechanical valve thrombosis was treated surgically. Of these patients, 70% were in NYHA class IV, including two in cardiogenic shock; 71% of the patients had inadequate anticoagulation levels. The median period between the initial valve replacement and valve thrombosis was 105 months. Thrombosis occurred in the mitral position in 12 patients (57%) and in the aortic position in nine (43%). Clinical and surgical data were collected from hospital records.
  
  
  RESULTS
  The major surgical finding was thrombus (57.1%), and pannus formation was found in 42.9% of patients. The mean cardiopulmonary bypass time was 90 min, and aortic cross-clamp time 63 min. Operative complications occurred in three patients (14%): two patients required revisions for bleeding and one patient needed ventricular assistance and hemodialysis. The operative mortality rate was 19% (n = 4). Two of these deaths occurred in patients who had been transferred to the operating room with cardiopulmonary resuscitation, one death was due to prolonged mechanical ventilator support and sepsis, and one was due to cardiac tamponade. The 11-year actuarial survival rate was 69.3 ± 12.9%, and the actuarial rate freedom from reintervention was 85.7 ± 13.2% during an 11-year follow up period.
  
  
  CONCLUSIONS
  Early surgical intervention is a safe and effective treatment in patients with mechanical valve thrombosis.
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Pablo
authors.initials: P
authors.lastname: Maria Alberto Pomerantzeff
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Padovani Steffen
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Manuel de Almeida Brandão
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Gisele
authors.initials: G
authors.lastname: Aparecida Lapenna
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Flávio
authors.initials: F
authors.lastname: Tarasoutchi
authors.affiliation: Heart Institute of the Medical School of São Paulo University, São Paulo, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Biscegli Jatene