Thrombolysis and surgery for mitral prosthetic valve thrombosis: 11-year outcomes

Background Mechanical mitral valve obstruction is a serious and life-threatening complication. Treatment is either thrombolysis or reoperation, with both interventions having its own merits and drawbacks. This study aimed to analyze the outcomes of both interventions at a single tertiary referral center. Methods From January 2005 to December 2010, 127 patients with mechanical mitral valve obstruction were retrospectively analyzed and divided into a thrombolysis group ( n = 66) and a reoperation group ( n = 61), based on our institute’s inclusion and exclusion criteria. A heart valve team comprising a cardiologist, a surgeon, and the patient was involved in the decision-making, based on the criteria for thrombolysis and reoperation in our institute. The patients had a maximum follow-up period of 14 years (mean 11.2 years). The analysis was divided into in hospital (within 30 days) and follow-up outcomes. Results At the end of 10 years, the reoperation group had significantly greater freedom from embolism (100% vs. 95.4% ± 0.7%), bleeding events (94.5% ± 0.8% vs. 89.2% ± 0.4%), and reintervention (96.4% ± 0.5% vs. 92.3% ± 2.3%) as well as better actuarial survival (97.4% ± 1.2% vs. 92.3% ± 0.4%) compared to the thrombolysis group. The complete failure rate of thrombolysis was 12%. The thrombolysis group had shorter intensive care unit and hospital stays. Conclusion Reoperation has significant advantages over thrombolysis in terms of embolic and bleeding complications and reintervention. Hence one should consider surgery for stuck mechanical mitral valves, with thrombolysis being useful in a specific subset of patients.