Valve thrombectomy in Patients with Acute Prosthetic Valve Thrombosis; Long-term results

Background: Prosthetic valve thrombosis (PVT) is one of the major causes of primary valve failure and is defined as any thrombus formation, near or attached to an implanted prosthetic valve, obstructing part of the blood flow or interfering with valvular leaflet motion. This report aims to present our clinical experience with the surgical prosthetic valve thrombectomy to address the morbidity and mortality of the procedure and late follow up. Method & Materials: Between February 2015 to February 2018, 32 consecutive patients with mechanical prosthesis thrombosis requiring surgical management and not suitable for thrombolysis or after failed thrombolysis, underwent surgical valve thrombectomy. Preoperative two-dimensional trans-thoracic and trans-esophageal echocardiography were performed in all patients to assess hemodynamic severity, thrombus size, and valve motion. Furthermore, fluoroscopy was performed to document abnormality in valve motion. Postoperatively, our primary endpoints were all-cause mortality and morbidity. Results: During three years 32 consecutive patients with a mean age of 55.07 ± 12.81 years (range, 35 to 82 years) underwent valve thrombectomy. The majority of patients were male (65.6%) and time to previous surgery was 7.9 ± 5.4 years. Valve thrombectomy was performed on mitral (23 pts), aortic (7 pts), tricuspid (1 pt), and both mitral/aortic valves (1 pt). Mean INR at hospital admission was 1.5±0.6. The mean CPB and cross-clamp time were 76.0 ± 34.4 and 49.3 ± 25.4 minutes respectively. Mean ICU stay of patients was 2.4 ± 0.9 (range 2–6) and mean hospital stay of patients was 10.0 ± 4.6 (range 5–23). Early or late mortality and recurrence of valve thrombosis was nil. Conclusion: Although prosthetic valve thrombosis is a serious complication with high morbidity and mortality, prosthetic valve thrombectomy seems to be a safe, rapid, and simple procedure in the majority of patients with low morbidity and mortality.