TY - JOUR
T1 - Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis
T2 - The Multicenter HATTUSHA Study
AU - Özkan, Mehmet
AU - Gündüz, Sabahattin
AU - Güner, Ahmet
AU - Kalçık, Macit
AU - Gürsoy, Mustafa Ozan
AU - Uygur, Begüm
AU - Keleş, Nurşen
AU - Kaya, Hasan
AU - Kılıçgedik, Alev
AU - Bayam, Emrah
AU - Kalkan, Semih
AU - Astarcıoğlu, Mehmet Ali
AU - Karakoyun, Süleyman
AU - Yesin, Mahmut
AU - İnan, Duygu
AU - Fedakar, Ali
AU - Sarıkaya, Sabit
AU - Aksüt, Mehmet
AU - Onan, Burak
AU - Koçoğulları, Cevdet Uğur
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/3/15
Y1 - 2022/3/15
N2 - Background: Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. Objectives: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. Methods: A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. Results: The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). Conclusions: Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.
AB - Background: Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. Objectives: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. Methods: A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. Results: The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). Conclusions: Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.
KW - echocardiography
KW - prosthetic valve thrombosis
KW - surgery
KW - thrombolytic therapy
KW - transesophageal echocardiography
UR - http://www.scopus.com/inward/record.url?scp=85125313768&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.12.027
DO - 10.1016/j.jacc.2021.12.027
M3 - Article
C2 - 35272803
AN - SCOPUS:85125313768
SN - 0735-1097
VL - 79
SP - 977
EP - 989
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 10
ER -