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Extracorporeal membrane oxygenation (ECMO) is frequently used for severe postcardiotomy cardiogenic shock in patients with bioprosthetic valves. Acute prosthetic valve thrombosis (PVT) is a rare complication after valve replacement surgery and significantly increases morbidity and mortality. Patients who develop PVT on ECMO could significantly influence the long-term durability of the bioprosthetic valves. However, previous studies only analyzed risk factor and treatment of the mitral valve thrombosis during ECMO support. The mechanism of thrombosis on the tricuspid valve was still unknown. Here we describe the symptoms and treatment of a valve replacement patient who developed bioprosthetic tricuspid valve thrombosis during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Meanwhile, the patient’s mechanical prosthetic mitral valve functioned normally. An emergency re-do tricuspid prosthesis replacement was performed, and the patient finally developed the successful decannulation. At 6 months follow-up, the patient showed asymptomatic and had a reasonable quality of life. The pathophysiology of tricuspid valve thrombosis may be different from the left heart. Our case highlights that the risk of thrombosis associated with a prosthesis in the tricuspid position can be even higher in the setting of VA-ECMO support. In such patients, promoting forward blood flow across the prosthesis and improving levels of anticoagulation may be particularly important.
Zhang et al. (Tue,) studied this question.