Recurrent Prosthetic Valve Thrombosis: Fibrinolytic Treatment for Recurrent Left Sided Prosthetic Valve Thrombosis

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Recurrent Prosthetic Valve Thrombosis: Fibrinolytic Treatment for Recurrent Left Sided Prosthetic Valve Thrombosis

Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 6

Abstract

Background: Prosthetic valve thrombosis is a devastating complication of valve replacement therapy. Many patients experience recurrent prosthetic valve thrombosis which is accompanied by increased morbidity or mortality. The Recurrent PVT (Prosthetic valve thrombosis) can be managed either by surgery or by repeat thrombolysis. Redo surgery carries with it more mortality and morbidity. There has been no large studies which evaluated the efficacy of re-thrombolysis in recurrent PVT. Objectives of the study were. 1) To assess the efficacy of thrombolysis in recurrent PVT 2) To assess the relationship of different patient variables responsible for successful thrombolysis. 3) To know the factors associated with recurrent prosthetic valve thrombosis. Materials and methods: This is a retrospective study. All the patients admitted at our institute with recurrent prosthetic valve thrombosis from Jan 2011 to Dec 2014 are included in the study. A total of 32 patients had recurrent PVT, all patients received thrombolysis according to the prespecified protocol. The effectiveness of the thrombolysis was analysed with serial echocardiography. Results: Mean age of the patients was 41.15±10.96 years. 17(53.1%) patients were females. Median duration following valve replacement was two years. 21(43.8%) patients had bileaflet prosthetic valve and 18(56.3%) were having tilting disc prosthetic valve. Only one patient presented with NYHA class I symptoms. Baseline echocardiography demonstrated peak and mean mitral gradients of 34.30±6.07 and 21.34±6.22 mmHg respectively. Whereas aortic prosthetic valve peak and mean gradients were 100.2±31.33 and 59.1±25.1 mmHg respectively. The mean left ventricle ejection fraction was 49.66±12.21%. Majority of the patients 21(65.6%) had normal or more than normal INR valve at the time of presentation. Neutrophil to lymphocyte ratio was significantly associated with the number of times patient was admitted with recurrent prosthetic valve thrombosis. At mitral position there were total 26 incidences of prosthetic valve thrombosis of which 16 (61%) patients had full response, 4(15.3%) and 6(23.0%) prosthetic valve thrombosis had incomplete and failed thrombolysis. In aortic position a total of 9 incidents of thrombosis were noted and all of these patients recovered completely following thrombolysis. There were two deaths and three embolic cerebral infarcts post thrombolysis, these events occurred in prosthetic valve thrombosis at mitral valve position and in NYHA class 4 patients. Urokinase and streptokinase had similar efficacy in the treatment of prosthetic valve thrombosis. Conclusion: Recurrent prosthetic valve thrombosis can be treated with thrombolysis with good results. Neutrophil to lymphocyte ratio was significantly associated with number of times patient admitted with recurrent PVT. Patients presenting with NYHA class IV have higher mortality and failed of thrombolysis. Recurrent PVT at mitral position had a higher failure compared to aortic position.

Authors and Affiliations

Shivashankara T H

Keywords

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EP ID EP209088
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